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Michael G. Kurilla M.D., Ph.D.

NCATS Director of Clinical Innovation

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“It’s tough to make predictions, especially about the future.”

By: Michael G. Kurilla, M.D., Ph.D., NCATS Director of the Division of Clinical Innovation

February 3, 2022

As we enter 2022, these words of Yogi Berra - baseball legend and philosopher - ring true and should engender some much-needed humility. Berra also offered sound advice to scientists: “you can observe a lot by just watching,” as well as an appropriate assessment on our overall public health response: “we made too many wrong mistakes.” It was only a scant six months ago that champagne corks were being primed to pop and then waning immunity (learned by way of Israel, UK, and Sweden), then delta, and now omicron has arrived. And so, while omicron may be tentatively on the decline, caution is advised.

 

Whether omicron version 2 (BA.2, AKA ‘stealth omicron’) comes in after or becomes something that looks more like a delta follow-on or perhaps adopts a Monty Python-esque ‘now for something even more completely different’ identity is anybody’s guess (alternatively, the Spanish Inquisition may not be far behind). Other recent revelations that are slowly being incorporated into general discourse are that cloth masks are not effective and airborne (rather than droplet) transmission predominates, as well as the degree of immunity conferred by infection that can have benefits for both vaxxed and unvaxxed individuals. One thing is for certain: we are unlikely to repeat behaviors (unmasking, large gatherings, etc.) from last year when declining caseloads observed in late winter / early spring were ascribed solely to vaccinations (an erroneous assumption due to modest vaccine uptake primarily in populations that were not the main drivers of caseloads). Unfortunately, we now recognize that the current crop of vaccines cannot block viral transmission. Since vaccinations have been observed to increase the frequency of asymptomatic breakthrough infections, herd immunity has been taken off the table for now.

 

Obviously, COVID is not the only consideration we are monitoring. Currently, we are still operating under a continuing resolution (CR) that runs through February 18. At this point, even with broad agreement on a full year budget, there will likely be at least one additional short-term CR to work out all the details. While seemingly unrelated, these Congressional machinations have impacted the CTSA program and were responsible for the elimination of the January receipt date. Uncertainty regarding the final nature of the CTSA appropriations required prudent action and elimination of that receipt date was the least disruptive action available.

 

Other changes with the new year include the transition of the CTSA Steering Committee (SC) co-chair from the NCATS Director to the DCI Director. Also, with the switch to a twice monthly SC meetings (1-hour each, rather than a single 90-minute monthly call), we have rearranged the agenda to ensure that pod feedback is given higher priority and I encourage all the CTSA PIs to utilize this channel for any issues, concerns, or ideas that rise above the level of an individual institution. In particular, we have become aware that there is still some lingering confusion regarding the recently released FOA suite. No matter how clear we might feel we have been, we can always refine to add clarity. Pod feedback and SC discussions have been valuable in clarifying meaning and intent. In addition, we recently met with the TL1 PIs to discuss our modelling assumptions and will conduct a similar event with the KL2 PIs. I should also add that last year I offered to join (annually) individual pod calls for a type of AMA (‘ask me anything’). Lastly, we are gradually returning to some sense of ‘business as usual’ and NCATS CTSA staff will be participating in the spring ACTS in Chicago (COVID permitting). I look forward to engaging with many of you in 3D.

 

“To learn which questions are unanswerable, and not to answer them:
this skill is most needful in times of stress and darkness.”

- Ursula K Le Guin, The Left Hand of Darkness

 

This Mike's Blog was featured in February 2022's Ansible. Subscribe to receive upcoming Ansible newsletters. 

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