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Interview with Dr. Florence Bourgeois

Interview with Dr. Florence Bourgeois

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 FOCUS In Sound #31: Florence Bourgeois Welcome to FOCUS In Sound, the podcast series from the FOCUS newsletter published by the Burroughs Wellcome Fund. I’m your host, science writer Ernie Hood. In this edition of FOCUS In Sound, we meet a Burroughs Wellcome Fund grantee who is researching issues related to the inclusion of children and adolescents in clinical trials. She has also recently published an important international study of pediatric COVID-19 patients. Dr. Florence Bourgeois is an Associate Professor of Pediatrics at Harvard Medical School and a faculty member in the Division of Emergency Medicine and the Computational Health Informatics Program, or CHIP, at Boston Children’s Hospital. She is a graduate of Yale University and Washington University School of Medicine in St. Louis. She was an NRSA research fellow and earned her Master in Public Health degree from the Harvard School of Public Health. In 2017, Florence received an Innovation in Regulatory Science grant from the Burroughs Wellcome Fund titled “Pediatric regulatory policy: advancing timely and rigorous evaluation of medicines for children.” The award was for up to $500,000 over five years. She has published several studies in the regulatory policy area, and this year she and her colleagues put out their work using electronic health records to track and analyze international trends in hospitalizations for children and youth with COVID-19. Florence Bourgeois, welcome to Focus in Sound… Thank you, thank you for having me. I’m delighted to be able to speak with you today. Would you sketch the broad outlines of the pediatric COVID-19 study for us? Absolutely. This study was a product of a large consortium that came together fairly rapidly at the beginning of the pandemic, so last March and April, leveraging existing infrastructure to be able to aggregate electronic health records across institutions. And not just institutions within the U.S., but internationally. And this presented a terrific platform to be able to look at pediatric patients in particular, since COVID-19 fortunately has had much lower morbidity and mortality in children. But this also means that the patient population that is accessible to us for study is much smaller. So we were able to take an international perspective to characterize the clinical presentation of COVID-19 across hospitals in a number of countries, and also demonstrate this type of large-scale, informatics approach to aggregating data in a rapid fashion, which is particularly important during the evolution of a pandemic like COVID-19. What conclusions did you reach? So we were able to find certain clinical features that were specific to patients with COVID-19, in terms of complications, as well as certain laboratory abnormalities, and we were also able to find that the data quality that we were able to produce using this approach was quite robust. So we are continuing additional studies now leveraging the same resource to dig into other aspects of COVID-19 specifically for kids. How did the study advance our understanding of epidemiological and clinical features associated with COVID-19 in children and youth? One of the findings was that there were abnormalities in coagulation in children. So that is a specific feature that has also been corroborated in other studies. So that would be one specific result. And another one is the complications we saw around cardiac rhythms, disturbances in cardiac rhythms, and also around seizure activity, as an example. So identifying those specific clinical features is another data point to guide further research. During the pandemic, many of the skeptics have been spreading the misinformation that COVID did not affect young people and children. Although rates and severity of infections have been lower, they are far from immune, aren’t they? That’s right. And in addition, not only can kids certainly be infected with SARS-CoV-2, so COVID-19, but they also have very specific and unique phenotypes. So for example, multi-system inflammatory syndrome is a phenotype or a disease presentation that we’ve uncovered that is very specific to children and not seen in adults. So understanding those disease presentations and being able to study them is certainly important. And beyond that, we’re concerned not just about kids being infected with COVID-19, but also their role in transmission and as vectors in the population and in the communities. So that’s another important factor to keep in mind, even if fewer kids are actually affected. So Florence, what are the wider implications of your findings? From this specific study, I think that one major takeaway is not even the actual clinical results, but really the methods themselves; this informatics approach to creating a network across institutions, across health care systems, and countries even, in order to characterize COVID-19. This could be extended ...
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