Jennifer Alvidrez, Ph.D.
Rick Berzon, Dr.P.H., P.A.
Dorothy Castille, Ph.D.
Nancy L. Jones, Ph.D., M.A.
CDR Nadra Tyus, Dr.P.H., M.P.H.
Division of Scientific Programs
The impact of the COVID-19 outbreak has strained daily life for people living in the United States, affecting nearly every sector including biomedical research. The disruption has also disproportionally affected the lives and livelihoods of populations that experience health disparities, which are also the populations that NIMHD’s research addresses.
To provide an opportunity to better understand the impact of COVID-19 on researchers and research funded by the institute, NIMHD hosted four COVID-19 NIMHD Investigator Forums this summer. NIMHD staff who hosted the events were Drs. Jennifer Alvidrez, Rick Berzon, Dorothy Castille, Nancy Jones and Nadra Tyus. We knew that the COVID-19 pandemic created many challenges for our research community and learned of the creative strategies they developed to navigate these challenges using their extensive connections with health disparity communities. We structured the forum to hear directly from NIMHD Principal Investigators (PIs) about their observations and thoughts in three areas:
1) Impact of COVID-19 on the communities where research is conducted
2) Strategies to modify recruitment, data collection, and/or intervention protocols
3) Understanding and addressing the impact of the pandemic on study outcomes.
First, the NIMHD research community expressed gratitude to be able to share their views on the impact of COVID-19 on their communities and their research teams, as well as to learn from their colleagues, and in some cases, form new collaborations. Although there were nuanced differences in experience and outcomes among the different health disparity communities, the researchers noted that these communities shared many similarities.
Addressing the impact of the pandemic on the communities where the research is conducted.
Nearly all research activities involving in-person contact had been stopped due to the pandemic. These decisions were made both out of concern for the burden imposed on these communities by COVID-19, and with caution to keep them and the research staff safe. Direct impact on these communities was seen with respect to COVID-19 cases, hospitalizations, and deaths, but they were also indirectly impacted, with multiple-sector disruptions effecting the community members’ wellbeing. On request by their community partners, many NIMHD investigators helped provide COVID-19 health information and linkages to resources and services. NIMHD PIs developed new partnerships to mitigate COVID-19 risks and enhance access to preventive measures in these communities; and at the request of their communities, they have increased their involvement in providing direct care and in helping navigate the available resources.
Strategies to modify recruitment, data collection, and/or intervention protocols.
Many investigators worked with their research staff and communities to modify their recruitment, data collection and intervention protocols. Investigators observed a general willingness of research participants to engage in online or virtual data collection and interventions. Some noted an increased enthusiasm to participate among individuals with more free time due to work or school closures. Investigators also shared suggestions on how they overcame connectivity barriers that made virtual participation challenging in some geographic areas or within some populations. Many surveys and behavioral interventions were modified for online, virtual or telephone collection. Although generally feasible and acceptable, these remote strategies were not always possible for participants with limited internet access, connectivity issues, or smart phones with limited data plans. Interestingly, several PIs noted that some participants preferred telephone contact over web meeting platforms like Zoom, to preserve confidentiality in more crowded living arrangements.
Many investigators reported specific challenges regarding biological specimen collection. Often, the laboratories had limited capabilities, and some areas encountered long delays in workflow because the laboratories were shipping biospecimens to other facilities for processing and analysis. Some investigators piloted mail-in biological specimen collections and one even mentioned considering a physical pick-up service. However, samples that required blood draws could not be collected remotely.
For studies that depended on recruitment in clinical settings, PIs were acutely sensitive to the increased demands of their clinical colleagues. Re-starting these studies required modifications to assure that they could work in the new paradigms of clinical care during a pandemic. Some projects, including those done in clinical settings or in schools, remained in a holding patterns, with investigators waiting to see how long the interruption would last before deciding whether to move to virtual participation or end enrollment early.
Understanding and addressing the impact of the pandemic on study outcomes.
The research community was especially aware of the fact that the pandemic would affect many of the key pathways and outcomes for their projects. Most investigators who had resumed data collection were collecting COVID-19-related data from participants to be able to tease out COVID-19-related effects on study outcomes. However, for some projects, the outcomes of interest were impacted so dramatically that controlling for COVID-19 related factors would not be sufficient. For example, school bullying does not occur in the same way when children are not in the school.
Investigators reflected that reporting study findings that occurred during the pandemic would need to explain issues such as missing data, lower enrollment, and the lack of definitive conclusions for research during this period. They hoped that scientific journals and NIH would provide guidance on how research is presented and interpreted to account for the impact of the pandemic on study outcomes.
Overall, it was clear from these investigator forums that the NIMHD research community is passionate about making a difference to the communities with which they are involved. Many of the investigators, research staff, and community collaborators are personally experiencing higher levels of stress due to the pandemic. Not surprisingly, the NIMHD research community continues to face these unprecedented challenges with creativity, flexibility, and tremendous resilience.