Brain Mapping in the Age of Covid 19: Global Insights

By Tzipi Horowitz & Nils Muhlert

Institutions throughout the world have had to adapt to the Covid-19 pandemic. Many scanning centres shut their doors during lockdown, and have had to reopen gradually, and carefully. We surveyed several labs from around the world - to find out the challenges they’ve experienced and, in a few cases, the opportunities afforded.

UK - Matt Wall (Head of MRI applications, Invicro, Hammersmith Hospital, Imperial College London)

Challenges: Everything shut down rapidly at the start of lockdown. In March, two big commercial scanning projects had to stop immediately. One had been running for some time, the other had just started. We had a lot of clinical people working with us - some very good medics. They spent a lot of time developing risk assessments and procedures. So we ended up restarting in late June. I tweeted about it at the time, and was contacted by people in other universities, asking how we managed it - so we shared our findings from the risk assessment process.

Our actions were consistent with the government guidelines: 2m social distancing and everyone wearing masks where possible, full PPE (masks, visors, gloves and disposable apron) where closer contact was necessary, particularly when getting people in and out of the scanners. As part of our risk checklist we also asked all researchers and participants to confirm that neither they nor anyone in their household had experienced flu-like symptoms and we used a heatgun to check each individual’s temperature as they entered the building. We ended up being ‘open for business’ before many parts of the university were.

We’re not back to capacity yet - particularly for PET. There we develop and use unusual PET tracers - we have a cyclotron onsite to make carbon 11 tracers which have a short half life. For this you need a large team, people involved in the chemistry, Q&A and PET technicians. There were many people on the furlough scheme so it was slow to start up again, and is only now back up and running. Overall, we’re probably at about 60% of what we used to do. 

Experience: There was a sense of anxiety to start but that resolved fairly quickly. Our collaborators, who are endocrinologists in Imperial University, were working on Covid-positive wards. They assured us that we were using similar procedures to those used when working with people that we know are covid-positive. That gave us a lot of confidence that we were doing the right thing. I was actually glad to get back to scanning. My research assistant, who runs the scanning, now goes in most days, and I’m in probably 2 days a week. My dog at home, who people may be familiar with on twitter, also calmed down during lockdown: no more chewed slippers. 

Opportunities: We found in our studies that it was suddenly a lot easier to recruit people. Once lockdown was easing, there were still many people off work. For one study we needed to recruit a particular population and since people were essentially bored they were much more willing to participate. Also the scanner was almost completely free.  We steamed through recruitment for that study in record time!

México - Eduardo Garza-Villareal (Lab Leader of the Computational and Translational Neuropsychiatry Lab, National MRI Laboratory, Institute of Neurobiology, Universidad Nacional Autónoma de México, Querétaro)

Challenges: There cannot be more than 2 people in the lab at the same time. Hence students are struggling to finish experiments. I mainly work with animals at the moment, and again, having very few staff is problematic. We were importing a rat strain from the US and in the end they stopped exporting animals and we couldn't finish that project. One of my students has to perform animal surgeries in another lab; she couldn't access the lab for one month. Another problem is student training, which is now impossible because you cannot be directly in contact with the students. Effectively, I'll see a work setback of 1 year or so. With TMS we do have human subjects but we are closed until probably January 2021, which is a big setback.

Adaptations: We are working remotely which has helped, however we would not be able to change population or projects now. We have also started to use public datasets for new research.

Because I have children my time is now more divided than ever with less time to think about research than before.

Canada - Rick Hoge (MRI Program Director, McConnell Brain Imaging Centre, Montreal Neurological Institute) & Julien Cohen-Adad (Functional Neuroimaging Unit, Polytechnique Montreal)

Challenges: All scanning stopped in March, except for clinical trials where imaging was a critical endpoint to evaluate treatment efficacy. Phantom and animal imaging activities gradually resumed in May. Human imaging restarted gradually in August. Many groups are eager to resume their studies and start new studies this fall. 

Adaptations: The core MRI staff and users have focused on remote work, including data analysis, hardware development, literature review, attending conferences etc. Zoom and other platforms are used to maintain group interaction.  On-site experimental work adapted protocols used previously for infectious controls are now used in animal neuroimaging research.

Gradually, we have adapted to the new normal, although scanning volumes are considerably lower than they were prior to Feb 2020.  The first groups to return to scanning were mainly those doing methods development and neuroimaging in animal models (as noted above, clinical trials work continued throughout the different phases of the pandemic).

New ways of working: The pandemic forced us to become more efficient at working remotely, using videoconferencing tools, telephone, and mobile messaging.  We were already using the Slack collaboration tool, but this was even more valuable since the pandemic began.  

Remote monitoring of MRI cryogenics was a particular concern during the complete shutdown, and we implemented several layers of security to make sure we could respond immediately to events like a quench or chiller failure.

Germany - Sofie Valk (Research Group Leader, Cognitive Neurogenetics, Max Planck Institute, Leipzig)

Challenges: My lab officially started March 1st. So, I guess two major changes occurred at the same time, namely that I now have to run and support a lab of my own, and get used to working following COVID-19. Recruiting has been different. For me, given that I am interested in computational neuroanatomy, genes, and evolution, it is not strictly essential to acquire my own data at the moment to answer the questions that we have and I also did not plan the timeline of my lab-start this way. My current research takes advantage of open data, so that my lab and I use Human Connectome Project data, as well as enhanced NKI, genome superstructure project (GSP), Abide, as well as data from the Primate Neuroimaging data-exchange and UK Biobank. Now I try to read up on how start-ups manage remote and home office working and how to build a team that can work that way. 

Adaptations: Remote work was a bit challenging at first, as I have two kids under 5 and daycare was closed. My partner and I had a shift system of one person 7am-1pm and the other 1pm-7pm and then work in the evening again. This kind of worked, but also resulted in little time for me, for sleep, or for my relationship. Often, I worked on my phone during my times with the kids, which I felt bad about. You can hardly call it the best of both worlds. For setting up the lab, the Max Planck Society supported funding for a researcher while this person was still abroad, which was very helpful. As the lab is oriented towards using open data, this meant we could just ‘start’. In the long run, we do want to acquire a good dataset for my lab to test more specific hypotheses, but there is no rush at the moment.

I try to be flexible and make the best out of the situation, and support the people that want to work with me. At the same time, home office and lab Slack make it sometimes feel work is always ongoing, whether I am in the office, playing with the kids, changing diapers, or in the sandbox. It is a novel challenge to also have ‘off’ time and to learn that, even if communication is always possible, most things can wait if needed. I am very fortunate with my team, because everybody is independent and mindful of each other.
Now in Germany, the situation has relaxed. Daycare is open, and most days I work at the institute, even though meetings are online. What has changed in me is that I now try to think of positive ways in which my lab can adapt, such as better collaboration, open science, database management.

Opportunities: I hope that the remote set-up can lead to sustainable changes. For example, collaborations and knowledge transfer with other labs not in the same building or hallway are easier now with Zoom talks. Also, it is nice to be able to give a presentation far away, without going there. Although flying to and from Montreal and Cologne with an infant (I was still breastfeeding at the time, and this seemed the best solution) made me feel like an international DJ last year, it was of course very tiring and bad for the environment. Now, I could just Zoom in from the kitchen table. Also, the lack of sleep and some challenges with work-life balance in the home-office has made me reconsider how I plan my time, and be more disciplined to take some time off, go for a run, and prioritize sleep a bit more. In the end it is a marathon and not a sprint.

USA - Fumiko Hoeft (Prof of Psychological Sciences, Mathematics, Neuroscience and Psychiatry, Brain Center Director, University of Connecticut, Storrs Connecticut) 

Challenges: Since mid-March, non-COVID in-person related research operations have been shut down in the US. Only COVID-related research and remote research was allowed (like most other US institutions). Staff and students were asked to work remotely. Some behavioral-only research moved to remote platforms. 
We conducted a survey beginning March to get a better understanding of the effect of COVID on our US-colleagues - we found that only 37% of imaging research centres remained open for a reduced ‘business as usual’:

Adaptations: Where possible, we moved to remote behavioral data collection but paused all imaging projects. Research, including human neuroimaging research, restarted in late May.

Behavioral testing remains remote whenever possible. For instance, we received NSF/Tremaine Foundation funding to start COVID related research. This is a project in K-Gr2 students examining the effect of an adoptive computerized reading instruction on children’s learning at home.

Israel - Yaniv Assaf  (Prof of Neuroscience, Head of the Alfredo Federico Strauss Center, Department of Neurobiology, Faculty of Life Sciences and Sagol School of Neuroscience, Tel Aviv University)

Challenges: Israel was in a lockdown during March-April 2020, and studies in humans were shut down. At the end of lockdown (May), we were allowed to have only 5 individuals in the lab. As we have 12 team members in the group with four paid employees, only one student was allowed to attend the lab every day. Teaching remotely using zoom or similar software has some disadvantages including the lack of interaction with the students.

During lockdown, the imaging center was closed. Scanning eventually restarted in May with several restrictions dictated by the ministry of health: we had to sterilize the scanner and the suite and build in a gap of 30 minutes between each scan.

Adaption: We shifted to one-on-one and lab meetings using remote meeting applications. On a personal note, I had more quiet time to myself, which allowed me to complete some of my ongoing work.

Opportunities: I started working with a team-management software, that assists with planning my team’s assignments. On the research perspective, we had an incredible opportunity to scan individuals that were scanned prior to the pandemic (prior to February 2020) and after the lockdown release. Individuals were willing (and probably had time and availability!) to come over to get scanned. We inquired whether there are neurobiological associations to changes in behavior related to social avoidance, interaction etc following COVID. Strikingly, we found that the post-lockdown group showed an increase in amygdala volume. Obviously, the pandemic enabled an opportunity to test the brain structural correlates for the behavioral stress that everyone was experiencing.

In summary, labs across the world have been forced to adapt, to find new ways of remote working and safe ways of scanning during the covid-19 pandemic. There is clear regional variation in how imaging labs between countries have responded, reflecting local infection rates and government policies. Many have increased activities with open datasets, and there are certainly improved opportunities to present virtually at a range of locations. We’re clearly not out of the waters yet, as Europe and North America currently see a resurgence of higher covid-19 infection rates. But at least this time, we are at least somewhat prepared for whatever 2021 brings.