Smilow and Yale Cancer Center Clinical and Research Town Hall | June 3, 2021

June 04, 2021

Information

Hosted by Nita Ahuja, MD, MBA

Presentations by Daniel DiMaio, MD, PhD, Akiko Iwasaki, PhD and Nathan Grubaugh, PhD, Roy S. Herbst, MD, PhD, Lynn Wilson, MD, MPH, Kevin Billingsley, MD, MBA and Kim Slusser, MSN, RN, and Tara Sanft, MD

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00:00All right, welcome everybody to town hall.
00:04Summer is finally here and I want
00:06to thank everybody for joining in.
00:08So before we get started I thought
00:10it be helpful to sort of stress
00:12that these town halls are monthly
00:14and they are going to be on the 1st
00:16Thursdays of the month at 5:00 PM.
00:19I'm going to remind everybody at the
00:20end that there is a survey at the end,
00:22so hopefully can connect in
00:24and the other part.
00:25I hope you'll see that from tonight,
00:27and if you were here last month is
00:29that we are hoping that this really
00:32reflects our broader mission of the
00:34of our all of our entity that we want
00:36to be an academic cancer system,
00:38and that means looking at both sides,
00:40both smilow cancer hospital or care
00:43centers and then Yale Cancer Center,
00:45which has all the basic signs and
00:47the research and clinical trials.
00:49So as you as we go along,
00:50I hope we can see that we're going to
00:53obviously talk about urgent issues,
00:54but also reflect all the wonderful
00:57things that happen in this large
00:59and wonderful organization that is.
01:01Us together,
01:02so hopefully you'll see as part of this,
01:05it's a busy agenda and I want us to keep
01:07going so we can have time at the end for Q&A.
01:10With that Renee next slide please.
01:12So reminder,
01:14ASCO,
01:15virtue Alaska starts tomorrow,
01:18and I know that there's lots of
01:20symposium in our faculty participating.
01:22It has both.
01:24Plenary sessions,
01:25educational poster presentation and for
01:27many of our there's lots of participants,
01:31I can tell you that an it's an
01:33opportunity for us to showcase the work.
01:35The fabulous work that's going
01:37on to a global audience,
01:39including all the innovative clinical trials,
01:42the basic science research that's
01:43going all the clinical research,
01:45so I want to wish everyone who's
01:47presenting good luck and best wishes.
01:49And it really is wonderful to sort
01:52of have all of you participating I.
01:55Hopefully next year will be in person.
01:58And this is the asko badge
01:59that to share on social media.
02:02If you go and tag and and tweet
02:04out something along the lines
02:06of this next time please.
02:07OK,
02:08this is all more further good news
02:10this the top docs came issue came
02:13out from Connecticut magazines.
02:14An 90 physicians from smilow
02:16cancer hospitals were named
02:18to the best doctors list.
02:20I mean this is amazing.
02:22It's an impressive accomplishment
02:23and it's nice to have that
02:26recognized by by the magazine.
02:27So congratulations to all of the
02:29people who are named on this next.
02:34OK, so also more good news.
02:37It's it's like an evening of good news,
02:39right? So more good news.
02:40I think all of you know that our
02:43COVID numbers are really coming down
02:45and that reflects all of the great
02:47work for all of us collectively.
02:49An also the vaccination rates that
02:52Connecticut is really leading
02:54in the nation simultaneously.
02:56It's nice to see that clinical volume
02:58so you can see alongside April of last
03:01spring if you can remember how we shut
03:03down a lot of our ambulatory operations.
03:06And so a big gift.
03:07An in dark blue is in person visits,
03:09and we picked up a lot of
03:12telehealth video visits.
03:13And then as you look in the fall,
03:14we really kept working across even
03:16though we had a late fall surge.
03:19As you know which I want to remind
03:21everyone that the fall surge
03:23was actually total numbers of
03:24patients as it was much longer.
03:26The total number of patients we
03:28treated through that was much
03:29higher than the spring surge.
03:30But then you can see in March
03:33and April the numbers have just
03:35skyrocketed along side.
03:36In in that reflects probably pent up
03:38needs of our patients as the long
03:41delayed cares and people are coming to us,
03:43and we've seen it.
03:44And I think you all are seeing that,
03:46and we're seeing that on both an
03:49inpatient and ambulatory site. Kate.
03:52Alright, moving to the next one.
03:54OK, this is perhaps not so good news,
03:57so I think some of you have seen
04:00the notices on that bread cross is
04:03experiencing a severe blood short.
04:05Short shortages on O blood type.
04:08It's all both positive and negative.
04:11It is affecting some beer beer
04:13managing this very well.
04:14Red Cross has been very helpful in managing,
04:17but there are some upcoming blood drives.
04:19You can see that and their local.
04:21So if you want wish to participate
04:22I think where.
04:23We would encourage that in there
04:25really on our site, so thank you,
04:27Renee for that and then moving
04:29on to the next slide.
04:31OK, so agenda, as I mentioned packed agenda.
04:33We have doctor Dan Dimaio who's going to
04:36lead us on some good news very quickly.
04:38And then Akiko Osaki is here along
04:42with Nathan. What's in Nathan?
04:45Doctor Nathan Growball to talk
04:47about all the stuff that they
04:48have been doing in COVID and.
04:50And if you don't know doctor,
04:52I was even sakis known as Doctor
04:54viral immunity on the in his
04:56been teaching the world about
04:57COVID and then clinical trials.
04:59Update by Rock Dr Roy Herbst,
05:01Radiation Oncology update clinical
05:02update by Kevin Dr Billingslea
05:05and Kim Slusser and then this
05:07is cancer survivorship month.
05:08Interesante will end off,
05:09so I'm going to remind our presenters.
05:12It's a tight agenda.
05:13I'm going to keep you on a.
05:145 minute times and don't let me
05:16kick you off the presenter menu,
05:18but with that I'm going to turn
05:20it over over
05:20to Doctor Tamayo.
05:22Thank you Anita.
05:23It's a pleasure to give again a
05:25little more good news than him.
05:27The podium quickly over to our
05:30speakers again the next slide please.
05:33The Cancer Center membership
05:34has been garnering awards.
05:36Jones Stites once again is gotten major
05:39national award for her work on RNA and
05:41two of our younger faculty member,
05:43Lillian Kobashi and City Chen,
05:46both at the West Campus,
05:47have received Pershing Square, so no prizes,
05:51and he this is to support their research.
05:52This is very nice.
05:54Ignition for them.
05:56Also, the next slide shows that
05:59our clinical work has been
06:01recognized by Yale Medicine.
06:02Both Delacy and Ron Salem have
06:05gotten distinguished career awards.
06:06It's a wonderful recognition for
06:08them for the long careers and Ruth
06:10Taliban have gotten an award from
06:12the Melanoma Research Alliance.
06:14So so congratulations to all these
06:18wonderful investigators and clinicians.
06:20But what I really want to talk about today,
06:22or to have you here today is about COVID-19.
06:26We all know the terrible toll it
06:28took on our patients and also how
06:31it disrupted our clinical service
06:33and disrupted research at Yale.
06:35You might not be so weird that
06:37that the yield is actually a real
06:39Center for COVID-19 research has
06:41made tremendous contributions to
06:43keep this pandemic under control.
06:45So we have two speakers to tell
06:46us a little bit about their work.
06:47First mate, Grubaugh, who tell us about.
06:50The emergence and spread of the
06:52virus that causes this disease.
06:54Then,
06:55Akiko is Saki will talk more about
06:57the disease aspects and further
06:58attempts to try to control it
07:00and understand it going forward.
07:02So Nate, if you can share your screen.
07:07Thank you.
07:10Thank you Dan and thanks for the invitation
07:14to present this work with you all.
07:16This is especially important for me
07:19because this has been a really close
07:22collaboration with the hospital,
07:23and in doing this work to enhance
07:26our Scooby to genomic surveillance
07:28for a community across the state.
07:30It helps with a lot of research objectives,
07:33but it's also just been a really
07:35important public health service
07:36that we've been able to provide.
07:40So this figure shows kind of our
07:46journey with with genomic surveillance,
07:48so the yellow bars are the number of
07:51weekly COVID-19 cases from the state
07:54of Connecticut and the purple lines
07:56represent the percentage of those cases
07:59that have been sequenced per week.
08:02And it shows that we went through
08:04a lot of different phases.
08:06So at the at the beginning we had
08:09this really amazing collaboration
08:10that Akiko is a big part of,
08:13but also many people in the hospital
08:15and the School of Medicine and the
08:17school public health called the
08:19Impact in that list to establish
08:21COVID-19 research here at Yale.
08:23And what my group did is during
08:25this this early period,
08:27our researchers focus on sequencing of
08:29the genome to understand the emergence
08:31of starts could be two in the state
08:33and we published this paper really
08:35early on that was that was surprising
08:37to many because that we found that
08:40the viruses that started the outbreak
08:42and Connecticut weren't from primarily
08:45from international introductions,
08:47that these were.
08:48This is the result of domestic spread
08:50and of course now we look back.
08:51And of course there's a
08:52lot of domestic spread,
08:53but when you think back to.
08:54It was from like March 2020 that
08:57that was really unknown at the time.
09:01And then there was a period from
09:04late summer two to fall where we
09:06didn't really do a lot of sequencing.
09:09A lot of routine sequencing at the time
09:10because there was a lot of interest
09:12from it in terms of a surveillance program.
09:14Then at this time that my lab was
09:16primarily working on diagnostics and
09:17on the sequencing front we were just
09:19working with the Department of Public
09:21Health on doing a lot of outbreak
09:24investigations to understand different
09:25outbreaks might be connected and related
09:28to things that the state we're interested in.
09:31Of course,
09:32the the interest in an sequencing
09:34changed a lot in December,
09:37and in the early part of 2021,
09:39with the emergence of stars,
09:40Kobe 2 variants,
09:41I think that we all saw then the importance
09:43of the work and the need to enhance this.
09:45So we were able to really quickly
09:48start working with the hospital
09:49in the diagnostic lab specifically
09:52David Paper and re Landrian with
09:53pathology as well and the Department
09:55of Public Health to start increasing
09:57our sequencing capacity to really
09:59understand what was happening.
10:01With with variants across the country
10:04and some of the work that we've been
10:06able to do with this in connection
10:08with collaborators across the country
10:09as they were able to show where a
10:11lot of the early B 117 outbreaks
10:13happened in the United States.
10:18And now we've. We've transitioned to
10:20this other space, which I'm calling,
10:22you know high definition SARS Co V2
10:24Genomic surveillance and I have this other
10:26symbol up here which is the symbol for
10:29our Yale genomic surveillance starts kovi,
10:31two genomic surveillance initiative that is
10:34really a big partnership with the hospital.
10:36The School of Medicine,
10:38the Yale Center for Genomic Analysis,
10:40the School Public health,
10:41but also some external partners
10:43in Jackson Laboratory and the
10:46state and and also now UConn.
10:48And we've been able for
10:50the last several months,
10:51sequence between 5 and 12%
10:53of the cases in this.
10:56These data allowed us to really
10:58build a track.
10:59The emergence and spread of a
11:00lot of different variants,
11:01so we're no longer caught off guard.
11:03We have a pretty good handle on what is what
11:06is being introduced here and importantly,
11:08now we're able to transition a lot
11:11of that work to help understand
11:13vaccine breakthroughs and
11:14sort of other future threat.
11:16We publish our data every
11:18Thursday at 4:10 PM.
11:20So just over an hour ago we had a new report.
11:23You can find it on COVID tracker.
11:25See t.com or you can follow us on Twitter.
11:27I'll have a little Twitter thread
11:29explaining all of this right after
11:31this is this is over and thank you.
11:36Thank you Nate.
11:36This is a tremendous amount of work.
11:38Pickup mobilized very quickly.
11:40Very appreciative and I think
11:42it's had national impact.
11:43So Akiko, if you share,
11:45you can tell us what you been
11:47up to over the last year.
11:50Thank you so much for this opportunity to
11:53share some of our just kind of a summary
11:56of what we've been doing and another is
11:58that you and so I'm going to pick up on
12:00what Nate was saying about this impact
12:03study that we collaboratively did and
12:06basically back in March of last year,
12:11some of us got together and created
12:14a biorepository called impact.
12:16It stands for implementing medical and
12:19public health action against coronavirus.
12:21Connecticut and it's a really a kind
12:25of became one of the most successful
12:28study group in the country to really
12:32tackle COVID-19 both viral infection
12:34as well as immune response.
12:36And obviously the surveillance.
12:39And you know,
12:40diagnosis and everything else
12:41just followed from this as well.
12:44So we wanted to really make this
12:47an inclusive effort and so we
12:50really wanted fellows and students
12:52and healthcare professionals.
12:53To get together and implement some of
12:57these very important research and also
12:59kind of really making elevation of
13:01the career of early stage faculty and
13:04trainees as as a key target.
13:06And I think we've been able to do that,
13:08and so I'm going to show
13:09you some of the results.
13:11This was our first impact meeting.
13:14Here's Nate you can see as well as
13:18Doctor Co from the school public health.
13:20He was the Pi of this repository.
13:24Doctor Saad Omer from the Institute
13:27for Global Health myself Ellen
13:29Foxman and Marine Laundry we all got
13:32together and started to you know,
13:34really think about how we can
13:37form this repository so everyone
13:40can benefit and study COVID.
13:43So we had a large number of
13:46people who had different roles
13:48by repository data management,
13:50impatient recruitment.
13:54Health care worker cohort outpatients,
13:57translational and viral efforts and
14:00you can see this is just a tip of
14:04the iceberg of who was involved,
14:06but it was also governed by the
14:09Board of Governors who oversaw all
14:13the requests for the buy repository.
14:16And what this allows us to do is to
14:18collect you know every three to four
14:21days biospecimen from patients who
14:23are in the hospital in the cohort,
14:26one who we collected, blood,
14:29saliva, oral, pharyngeal,
14:31nasopharyngeal swabs,
14:33feces,
14:33urine and in some patients mini ball
14:36so that we can start to look at immune
14:39responses and viral replication in real time.
14:42And this has really led to a lot
14:44of insights that helped us.
14:46Kind of try to tackle this infection.
14:48We also have an outpatient cohort as
14:50well as the health care worker cohort,
14:52which served as a uninfected control
14:58and using this impact cohort we
15:00tackled a large number of questions.
15:03We meaning a lot of people involved,
15:05I'm just here to as a messenger,
15:08so one of the key issues with kovit is
15:11that it's a very heterogeneous disease
15:14really, really varies between people,
15:15how they respond and how
15:17they recover and how they.
15:18Suffer from this infection and so we
15:21focused on different immune responses
15:23that occur in people with asymptomatic
15:25all the way to fatal infection.
15:28And we published several papers on this
15:31front looking at how the immune system
15:34fails in the severe and fatal COVID,
15:37and in addition it's we also saw
15:40signatures of the immune response
15:42that's contributing to disease.
15:44So in the late phase severe COVID.
15:47Basically we found out that.
15:49Immune responses goes awry.
15:50An all kinds of arms that the
15:53immune system gets engaged in.
15:55It's really the immunopathology
15:56that may be driving the disease,
15:58whereas earlier phase of the disease
16:01is caused by the virus itself,
16:04and we've also been looking at
16:06differences in immune system.
16:08Immune response in male and female
16:10patients identified one of the first
16:13differences in COVID and that may
16:15explain some of the differences
16:17we see with risk for severe and.
16:20Fatal disease in the male cohort.
16:23We've also been looking at long
16:25haul or disease.
16:26In particular,
16:27antibodies that develop against
16:29their own cells.
16:31They autoantibodies we published
16:33with Doctor Aaron Ring.
16:35Diverse array of autoantibodies
16:37that occur in COVID patients.
16:39It's almost sort of.
16:41You can consider some of these
16:43disease features as autoimmune.
16:46We've also been with Doctor Shelly
16:48for Hardy and been looking at the
16:51impact of COVID-19 in pregnancy,
16:53causing both severe impact as
16:56well as some more subtle impact
16:59that occur within the placenta.
17:02Doctor Carrie Lucas and Doctor Kevin
17:05Harreld have been looking at children.
17:07How they respond differently to COVID
17:09and how they can recover versus
17:12some of the Missy kind of features
17:14that are occurring in some children.
17:17So yellow has done a lot of investigation
17:19in this heterogeneity of disease
17:22in the last couple of minutes.
17:23I just want to kind of think
17:26about what's next and so we are
17:29very interested in figuring out
17:31what Long Cove it is all about.
17:33And especially we are hearing from
17:36patient based groups that about
17:3730 to 40% of the long haulers.
17:40Are feeling better after vaccination
17:42and this provides us a window into
17:44which we can understand the disease
17:47itself as well as potential therapy.
17:49So we are now recruiting people who
17:52have long hauler disease prior to
17:55their vaccination and also after the
17:58vaccination in we're following how
18:00their immune responses differ and how
18:03that relates to symptom improvement.
18:06And we're measuring a lot of different
18:08immune features so we can understand.
18:10Both the disease process itself as
18:12well as therapy, and so just briefly,
18:14we think that are a couple of reasons why
18:17people are having long hauler disease first.
18:20It may be that there is a persistent
18:22virus infection that's somewhere in
18:24the body causing chronic infection,
18:26chronic inflammation, and that can be
18:28dealt with by vaccine induced antibodies,
18:31which can potentially clear
18:32these kinds of reservoir.
18:34Second possibility,
18:35as I mentioned,
18:36is the autoimmune disease that's
18:37occurring in some of these patients,
18:39an immune.
18:40Vaccine induced induced immune
18:43cytokines can temporarily dampen
18:45these kinds of autoreactive cells,
18:48and so we're looking into
18:50these kinds of possibilities.
18:52And we have a great team here
18:54at Yale COVID Recovery study.
18:57So Dr Harlan Krumholz is the Pi
19:00of this study and I'm a copy.
19:02I'm and Daisy Massey.
19:04A postcard is really kind of
19:06spearheading all the efforts in
19:08this front and many a wonderful
19:10collaborators listed here are
19:12helping out with this study,
19:14so I don't want to go over time.
19:17I'm going to just desktop share here.
19:19Thank
19:19you. Doctor Masaki and thank you dad Trueba.
19:23Next up we have Doctor Roy Herbst
19:25giving us a clinical trials update.
19:34Thank you Anita,
19:36and it's really a pleasure to be here.
19:39Unfortunately, I'm here.
19:40I'm taking this role as Roy
19:42Decker recovers from his illness,
19:44but it was my pleasure to help out.
19:45And as you'll see,
19:47we're making some progress.
19:48Much of it that was begun
19:50with Roy and the entire team.
19:54Well, I want to start with just
19:56a quick patient story and why
19:57clinical trials are so important.
19:59So this is Maureen Marine
20:01was on a clinical trial.
20:03She came to Yale 11 years ago.
20:06This is before there were any.
20:08I mean our therapy trials, by the way,
20:09going on in Indiana's and I know that
20:11'cause I was at MD Anderson back then,
20:13but she was getting a trial of a
20:15drug that's now known as Nemo Mab,
20:16with Scott Gettinger,
20:18Mario Small and Hairy Cougar
20:21and she had wonderful response.
20:22She had refractory disease.
20:24She wouldn't have very much time at all,
20:26less than a year,
20:27and she's now alive and strong.
20:29Eleven years later.
20:30That was a clinical trial here at Yale.
20:33So we have a couple of things
20:35we're doing right now.
20:36We really want to have the most
20:38safe and efficient clinical trials
20:39network we possibly can have.
20:41We're modernizing where we were getting
20:43a great deal of help from the YCC.
20:46I much appreciated from an
20:48outside consultant you're on and
20:50together with our current team,
20:52we're really building a
20:54clinical trials office.
20:56It's going to be even better than
20:57it was before we're improving our
20:59standard operating procedures. Why?
21:01Because this is an electronic age.
21:03We need processes.
21:04Where we can sign off on regulatory
21:06documents electronically,
21:08we want the investigators to have
21:10increased responsibility and oversight.
21:12We're all working together as a team
21:13and we've been working very closely
21:15with one of my other hats with the
21:17DART leaders to make that happen.
21:18We're recruiting staff.
21:19We got somewhat low in staff during COVID.
21:22It's been a tough 14 months.
21:24We've seen that and thank you to all that.
21:26All the work that was done here at yeah,
21:28but now we're recruiting an A
21:30lot of recruiting is going on and
21:32just this week we've made eight
21:33or nine offers for really good.
21:36Staff were focusing on education
21:37and training of the staff,
21:39were bringing on a younger and newer staff,
21:41so we want to make sure that
21:43they are supported and trained,
21:44and we're doing that.
21:45And then we want to activate more trials,
21:47but to make room for the new trials
21:49we have to close them all trials.
21:50So that's something I've been very
21:53involved with with the entire team care
21:56Pavlik Sarah Boynton the entire team.
21:58So just to give you an exact some
22:00some sense of the magnitude of
22:02the task you can see here trials
22:04that are open to accrual.
22:06There are 238 trials open to
22:08accrual at Yale and 622 translator.
22:11Active doesn't translator still open
22:13because there are some patients being
22:15filed but no one has is currently going on.
22:18And then if you look open since March 1st,
22:2031 trials of open,
22:21so where we've gotten things cranking again,
22:23we're opening trials.
22:25We're prioritizing trials,
22:26and we've closed 38.
22:28Really proud of that and then none
22:30of them have been closed completely,
22:33so we've closed them.
22:34You know,
22:34to accrual, but then we
22:36close them completely,
22:37making room for the newer the better.
22:39Science, the science coming
22:40out of the labs like Leaping,
22:42Shine, Ehrenring, Akiko,
22:44all people you've just heard.
22:46So look at patients on trial.
22:48So we had a newsletter.
22:49I hope everyone got it,
22:50and I think Nita and Renee and
22:53and everyone for their help on
22:55this and you can see that we
22:57put 47 patients on trial in May.
23:00Would we have liked more?
23:01Sure, but we could have had less.
23:03We're keeping our momentum going
23:04and I'll show you in a moment
23:06that the curve is heading up.
23:08312 patients are still on treatment
23:10at the main campus, New Haven,
23:12but 122 at the care centers.
23:15So we have a number of patients
23:16that are under treatment,
23:17so we're pretty busy.
23:21Now if you look at the types of trash,
23:23this is important about half
23:25of them are industry trials,
23:26but actually quite nice.
23:27About half of them are either cooperative
23:29group trials where there's been a lot
23:31of input you know from from our team.
23:33We're one of the leading sites
23:34in the Southwest oncology group,
23:35the SWOG through the National
23:37Clinical Trials Network,
23:38and you can see 15% of these or
23:40investigator initiated meaning they've
23:42directly come from a real science.
23:44So this is good.
23:45I'd love to see this piece a little
23:46bit bigger and we're working on that.
23:48There's enough signs here to make this
23:50at least a quarter or even a third.
23:53And here I I told you you can
23:55see back from last January and
23:57we were already a little bit low.
23:59We were already trying to fix
24:00things a bit back then,
24:01but then we took this dip we
24:03actually had to close trials for a
24:05month or two because of the virus,
24:07but we've gotten back up there and look.
24:09We're beginning to get to those levels,
24:11so a positive trajectory.
24:12Do I want to do better?
24:14Absolutely we will,
24:15but thank you to everyone at the
24:17entire team for all they've done.
24:20So we have a work stream activation team.
24:22We just took this picture today so
24:24we're meeting at multiple times a
24:26week to try to open more trials,
24:28use the You're on team.
24:29The YCC team find ways to identify
24:32the trials closer to opening.
24:33Unless the gateman's been working
24:35very closely with us on this,
24:37Mallory of course works.
24:38Here she's one of our regulatory
24:40team by Jesse Ragna announce
24:42and they're all with urine.
24:44Sarah is is our is our leader right
24:47now and they've got me to join.
24:49But we opened four trials last week.
24:51And we closed.
24:52One doesn't seem like a lot,
24:53but it's really good progress and
24:55the momentum is is moving forward
24:58really making some progress.
25:00So I just wanna show you an example of
25:01what we're opening their their varied.
25:03Here's a trial of Marriag Ocean.
25:04So this is a surgical trial in breast cancer,
25:07so you can see surgery versus
25:09active monitoring.
25:10Here you can see Andrea Silver a
25:12try for triple negative breast
25:14cancer immunotherapy and adding a
25:16vaccine and neoantigen vaccine.
25:18This is a little bit of a rare population,
25:19but it's an important population,
25:21so this is open.
25:22This trial, Barbara Burtness.
25:24I think this is going to be very popular.
25:26Very high accrual because it's
25:28a drug lab at Neb.
25:29That's a multitype tyrosine kinase
25:31inhibitor targets vascular in
25:32affiliate growth factor being added
25:34to pembrolizumab in patients who
25:36are resistant to immunotherapy.
25:37This trial is now up in accruing
25:39both on the main campus and the care
25:42centers and then actually by coincidence,
25:44one of my trousers in the queue
25:46just by coincidence.
25:47And this is a trial of another
25:49checkpoint inhibitor known as ticket
25:50anti TIGIT and this is this is actually
25:52on going. And we're accruing as well.
25:55I just want to say that you just saw
25:57it from Akiko the impact program,
25:59and, you know, Wade Schultz here was
26:01very involved in that. You know,
26:03creating the whole computational database.
26:05On Ed, Captain Ann Wade and the team
26:07here Christina Weiss Big shout out.
26:09She's the CTM for the GI team working
26:11with Pam Neal at the care center.
26:13They are now doing a clinical
26:15trials matching project.
26:16How amazing, in real time they're going
26:18to use the database linked to Epic
26:20that tell us who Ann where patients
26:22are eligible for clinical trials.
26:24This will help us both in our feasibility
26:26planning but also to find those
26:28patients who can go on trials with all
26:30the different eligibility criteria.
26:32I'm not going to say too much of this
26:33time mentioned in her grand rounds.
26:35Two weeks ago, but good things are happening.
26:37Where and we also want to find
26:39more diverse patients.
26:40We want to put more minority
26:41patients on trials.
26:42This will help us to find
26:44them throughout the network.
26:46Finally, I hope you saw the newsletter.
26:48We highlighted some of our staff here
26:49are two I'd love for people to send me.
26:51Emails were going to put this out
26:53monthly with staff they recommend for
26:55highlights will get them out there.
26:56I just want to give a shout out to Heather.
26:58She's on the lung team Heather.
26:59I actually one of my first actions in
27:01this role was to send her to help the Q team.
27:04I wasn't that popular with my own team,
27:06but she did it with a smile and
27:08she's just a great nurse research
27:09nurse and has done a wonderful job.
27:11And Christine Lee,
27:13who is a regulatory manager who's
27:15just an amazing job.
27:16So finally I just want to tell everyone
27:19we're moving in the right direction.
27:20We do have a ways to go we're hiring.
27:23This is some outings we've had just in
27:24the last few weeks of the lung team.
27:26I happen to be there so I had some pictures,
27:28but I'd love to see every team
27:30getting together supporting each
27:31other and then just the other day
27:32in the clinic I met a patient.
27:34Scott Gettinger had me come into a
27:35room and he said Doctor Herbst it
27:37was a pleasure meeting you yesterday
27:39during during my visit with Doctor
27:41getting here it was very quick and
27:42actually if I showed you my sincere
27:44appreciation to everyone that smile,
27:46I've been going there since I
27:47got into the clinical trial.
27:48Four is now active out in 2012.
27:51We help this man.
27:52He's alive only because of
27:54our clinical trials office.
27:55It's been nine years and my scans
27:57are still clear and all that time.
27:59I can't remember one time that I was not
28:01treated with the utmost kindest by everyone.
28:03The nurses the clinical trial staff,
28:05volunteers and doctors smiles
28:07and good words go along way when
28:09you're dealing with an illness.
28:10So I just want to stress we're doing
28:12important work where pulling together,
28:13we hope for the best that Roy
28:15Decker will come back soon.
28:16Thank you very much.
28:19Thank you Doctor Herbs
28:20for that fabulous update,
28:22and I want to publicly state my gratitude
28:25for stepping in as our acting chief.
28:27You stepped in with both feet
28:29and graciousness and really have
28:32been doing huge amount of work.
28:33I think is all of us can see
28:35obviously a lot of it was built with
28:38Doctor Decker and that our support
28:39teams and also I think what draw.
28:41So seeing is we want to be
28:43transparent and share all the data.
28:44So the newsletter I felt was
28:46fabulous and then just to see this
28:48data so will continue to do this.
28:50Monthly, this is important work you
28:51showed some why it is important
28:53with those great patient stories.
28:55So thank you Roy.
28:56Next step,
28:57I think is Doctor Wilson to give
28:59us a radiation oncology update.
29:02Thanks nita. This will be brief and
29:05much more uplifting and less stressful
29:07for this group compared to last month.
29:10And I say that because as most of
29:13you know we were in the throes
29:15of managing the resultant.
29:17Challenges that were associated with
29:20the third party vendor cyber attack,
29:23which brought all of our systems down
29:25across the network for several weeks,
29:28so we were forced to.
29:31Develop and put into play
29:33alternative modes of treatment for
29:35our patients which worked well.
29:37So the news today is good.
29:39In fact, this week we're treating
29:41approximately 300 patients a
29:42day throughout the network,
29:44which is very close to the highest daily
29:48numbers that we've ever seen in the
29:52program and within the next two weeks.
29:55All of our patients will be back and
29:59managed in the standard clinical record
30:01and verify mode prior to the cyberattack.
30:04There aren't very many patients
30:06left in the file mode technique,
30:09but there are a few,
30:10but they'll be coming off that
30:11mode soon as soon as they finish
30:14their treatment program.
30:15So things are going very,
30:16very well and very efficiently,
30:20so that's excellent news.
30:23We have some.
30:24Nice equipment changes.
30:26We have a we have two CT
30:29simulators in New Haven.
30:31One of them has been decommissioned
30:34is actually I believe being removed
30:37tonight and will be replaced by a
30:39wide bore CT to match the other wide
30:42bore CT that we currently have,
30:44which will be a great addition
30:46to the program.
30:47In addition it will have some
30:49other nice technical upgrades.
30:51The downside on that is since these are.
30:54Complicated installations with
30:56commissioning associated with them.
30:58It will take a couple of months to have
31:02this up and running, but that's OK.
31:04The other CT can handle the load.
31:06Of course there is some scheduling
31:08inconvenience because of that,
31:10but there will not be any delays
31:12in the management of our patients
31:14because of this. So that's good news.
31:17Also,
31:17our CT simulator in Guilford is
31:20also being replaced,
31:21which is good news in those patients.
31:25Again,
31:25are all being seen and treated
31:27in a timely fashion,
31:28and we've worked out a program where
31:30they undergo their CT simulation.
31:32Most of those patients anyway
31:33at our Hamden facility,
31:35so that's been moving very, very nicely.
31:38A bigger piece of equipment,
31:40news is we have four linear
31:42accelerator's in New Haven.
31:44One of them has just been decommissioned
31:47very recently and will be replaced.
31:51A very in Truebeam device we already
31:53have one of those linear accelerators,
31:57so this will be a very nice
31:59replacement device.
32:00But again it takes a long time
32:02for the removal installation.
32:04These are big pieces of equipment,
32:06highly technically complicated
32:07with a lot of radiation therapy,
32:10safety commissioning associated with
32:12it so that device will not be up
32:15and running probably until October.
32:17The downside of this is in all
32:19departments face this all the time
32:21whenever they have to replace equipment.
32:23So we're used to this,
32:25but we're on extended hours.
32:26We do not believe in waiting lists
32:28for our patients, so we take care
32:31of everyone by extending the hours.
32:33So we're basically treating patients
32:35from 6:45 or 7:00 in the morning,
32:37which is typically when we start.
32:40But now instead of being
32:42done around 5:00 or 5:30,
32:44there are patients being treated up
32:46until about 7:00 o'clock in the evening,
32:48which of course is inconvenient
32:49for some patients.
32:50But remarkably, there are.
32:51We always encounter patients who prefer that.
32:53Because that makes it easier for them to get
32:55their treatment after they're done with work,
32:58so it's not as bad as it sounds,
32:59and our staff is used to
33:01doing this sort of thing,
33:02so it's another good piece of good news,
33:05but it will take a couple of months,
33:07but in general, things are going very well.
33:09We have emerged successfully
33:12from the cyberattack challenges,
33:14so morale is much better.
33:17Efficiency is much better.
33:19There are a few pieces in
33:22terms of historical data.
33:24That we have garnered from the cloud,
33:27which will allow us access to all of
33:29the history on all of our patients.
33:32We're not quite there yet,
33:33but should be in the next couple of weeks.
33:34That's also another piece of good news.
33:36We were concerned that those date of may
33:38have been corrupted during the cyber attack,
33:40but indeed they were not.
33:42So that's good news in the last
33:44piece of information dovetailing.
33:46Often his comments regarding ASCO Astro,
33:49the Radiation Oncology International
33:51meeting will be taking place this year.
33:53The end of October in Chicago Live,
33:56which will be exciting.
33:57So thanks very much for the time.
33:59Well,
34:00that was really great news.
34:01And as you said lot,
34:02you know what your team had to go through
34:05and I'm really excited that that all
34:07our patients are being taken care of.
34:08And also, more importantly,
34:09you're also getting some state
34:11of the art machine.
34:12So congratulations to all of you.
34:14Thank you Lynn.
34:16Next, I think we have a clinical update
34:19with Doctor Billingslea and Kim Slusser.
34:21I don't know who's going first.
34:24Alright tag team are dynamic dual.
34:29Thank you Nita. You know,
34:33I will say that this is been a truly
34:37gratifying week for Kim for myself,
34:40for our all of our clinical teams.
34:43I think many in the audience know that we
34:47had the the pleasure of moving our surgical
34:51oncology team back in to NP 15 this week.
34:55And as much as it was enormously
34:59gratifying to bring that team home,
35:02it was also a difficult and poignant
35:06team a poignant moment as we consider.
35:10The history of COVID care
35:13in this institution, and.
35:17And the fact that NP 15 was really
35:20Ground Zero for caring for hundreds
35:23of patients for COVID at Yale,
35:25New Haven Hospital over the past 14 months.
35:29There was a wonderful ruin remembrance
35:33ceremony yesterday in the morning with
35:36many of our staff as well as our leaders and.
35:40And I think it was a fitting tribute
35:42to the dedication, compassion and
35:45excellence of the mini physicians, nurses,
35:49and staff that work tires tirelessly
35:52for for days, weeks and months on end.
35:56Take care for patients
35:57through the pandemic there.
35:59But we are.
36:00We're enormously happy to be back on it.
36:03MP15 and.
36:04We will be moving the women's oncology
36:09program back to NP 14 next week.
36:13I have some some.
36:16Some gratitudes to share,
36:17but Kim,
36:18let me ask if you want to
36:19jump in at this point.
36:23I mean, the only thing
36:24I I just want to also echo what Kevin said
36:28around the remembrance ceremony it was.
36:31It was quite touching and it was also pretty.
36:35It it really brought back
36:36I think to a lot of people.
36:38Some of those early day memories and you
36:41know they shared what that MCU team had
36:44to experience over these past 14 months.
36:47And you know they mentioned that they had to
36:52witness 300 deaths just on that unit alone.
36:55And but they were able to also
36:57witness Four Weddings, and it was
37:00just a really great reflection time.
37:02And it was.
37:03Then especially great to know that
37:06we no longer need a 28 bed COVID ICU
37:10unit at Yale New Haven Hospital.
37:13I think that that is what we celebrated
37:15and then to be able to bring our surgical
37:18oncology unit back to their home on MP15.
37:21And it was great to walk around the unit
37:24in the evening and see our team members
37:26back up there and we can't wait to
37:29welcome women's oncology back next week.
37:31Go ahead, Kevin.
37:34So I do want to say
37:36a special note of thanks to our
37:39multidisciplinary teams who have
37:42cared for patients with women's
37:44cancers at the Saint Berryfields
37:46campus for the past 14 months.
37:49The work of the nurses under the
37:52leadership of Sarah Infantino
37:54has been absolutely brilliant.
37:57And you know, we often talk about
38:00heroism and we think of it is is
38:03singular dramatic activities.
38:05But what I think is often most
38:09to me most impressive is,
38:11is that quiet heroism of everyday service.
38:15In this group of nurses came to work every
38:19day under challenging circumstances,
38:22caring for a difficult group of
38:26patients in a challenging environment.
38:28With patients undergoing surgery
38:30here at the York Street campus.
38:32Transferring by ambulance to
38:35Saint Braves without their usual
38:37support structure around them.
38:40So I, I just can't.
38:43Can't say enough for all deeply grateful.
38:46This same gratitude extends to Vanna.
38:50Dest and her team of Aips that
38:52worked hand in hand with the nurse,
38:54is providing outstanding around the
38:57clock care for patients over there.
39:00We had wonderful support from our
39:03hospitalist colleagues under the
39:05direction of Laramidia and will pushing,
39:07providing some additional support.
39:09And, of course,
39:11our G1 GYN Oncology service surgeons.
39:14Providing care at both campuses,
39:18sometimes operating at two campuses
39:20in one day.
39:21Covering centrical emergencies on
39:24York Street while rounding at SRC.
39:27Doctor Ratner and her team,
39:29including doctors and sodium
39:31and eras santine,
39:32all Twigger Clark weighing and icky.
39:34And we're all deeply grateful.
39:37I know there are probably
39:38people I'm leaving out,
39:39but I will just say this was
39:43truly a Herculean effort on behalf
39:45of all of our our patients.
39:48Thank you.
39:54And then another milestone for us is,
39:57you know, on March 9th we formed
40:00a smile COVID-19 response team.
40:03But then after a few months turned
40:06into a monitoring and transformation
40:09team and we had hundreds of meetings
40:13of this team and we are May 28th.
40:16We sunsetted this team again.
40:18Another just amazing milestone for us.
40:22We do recognize that there is still
40:25disruption and there is still displacement
40:27and there is still a lot of work we
40:30have to do throughout this pandemic,
40:32but the fact that we are at a
40:34place where we no longer have to
40:37bring this large group together,
40:38it really gave us also another time of
40:41reflection to see everything that was
40:44accomplished over the last 14-15 months.
40:48An really came out of this group of
40:52over 60 multidisciplinary team members
40:54across Yale Cancer Center and Smilow.
40:57An other department's in the hospital,
41:00and again,
41:01it wasn't those 60 individuals
41:03that did all this work.
41:05It was every single person within
41:07our community across Yale Cancer
41:10Center and Smile.
41:11Oh, but the fact that we were able
41:13to create over 30 working groups,
41:16an accomplished over 100 what
41:17we call just do it.
41:19Action items that stand across relocations,
41:24changing clinical pathways.
41:26Creating new protocols.
41:28Opening up a new clinic and a new
41:32monitoring call program for our patients
41:35that experienced COVID transitioning
41:37hundreds of staff to remote to remote
41:41work and successfully care for patients.
41:43It's just amazing to see what our
41:46entire enterprise had accomplished
41:48while still delivering excellent
41:51clinical care to our cancer patients and
41:54ensuring a safe workplace for our teams.
41:57And I just.
42:00Was.
42:01Very grateful to be part of this team.
42:05Throughout all of this and continue
42:06to be proud every day to come to
42:08work and work with this amazing team.
42:12And I think also some of the things
42:15we can really take away from this
42:17team is that now we have a playbook.
42:20We have all of the work that we did
42:23previously and I think if we ever had
42:26to go through something like this again
42:28we're just more prepared and we're
42:31also more prepared now and how we.
42:34Look at our clinical operations again.
42:37This group moved into a transformation team.
42:39We formed forward transformation teams
42:42inpatient ambulatory clinical trials,
42:45and supportive care services.
42:48Ann are ambulatory transformation
42:50team and are supportive care services.
42:53Transformation team are still very,
42:56very active with many,
42:58many initiatives that is transforming
43:00care across our enterprise,
43:02and that work will continue.
43:04So just by sunsetting this,
43:06it doesn't mean that the work is done,
43:08but it is a milestone where we no longer
43:10have to bring this group together as
43:13frequently as we had in the past.
43:15And we are able to sunset.
43:17And with that we're also able to look ahead.
43:20So one of the things we really learned
43:22about this whole process that we went
43:25through is that we really valued the
43:27forum of bringing so many different
43:29people from our enterprise together
43:32to talk about clinical care
43:34delivery in our clinical operations,
43:36an with the launch of our disease centers,
43:39it's going to be critically important
43:41to have some type of forum where
43:44we bring again our diverse group of
43:46team members together to talk about.
43:49Clinical activities so we will be
43:51forming a Yale Cancer Smith Center
43:54Smilow Clinical Council that Kevin
43:56and I will Co chair and it will really
43:59serve as a form for this continued
44:01work of our transformation teams,
44:03and it will also provide a venue for
44:05disease center clinical leaders and
44:08smiling multidisciplinary leadership
44:09to exchange best practices and be a
44:13setting where we can discuss innovation
44:15and can can ensure our care signature
44:18across all of smilow So we're really
44:21looking forward to the launch of that.
44:22There will be more to come in more
44:25specifics about this and future town halls.
44:27We hope to have this Council up and
44:29running sometime this summer, but again,
44:32just a very significant milestone.
44:38In our work through this pandemic and Kevin,
44:40I'll just let you close out.
44:43Thanks
44:44Kim, I have very little
44:45to add except powerful
44:47lessons learned an I think.
44:49We do have an opportunity to take the the.
44:56The lessons that we've learned
44:57in our knowledge that we can work
45:00quickly and effectively as a nimble,
45:03cross functional team that spans
45:05this entire organization and and
45:07we're going to carry that forward.
45:10The Clinical Council is going
45:11to be a great venue for that,
45:13and I know we're all looking.
45:15Forward to.
45:16Continued growth in our organization.
45:19Thank you Kim and Kevin for that
45:21nice update and also for announcing
45:23the news that I think a lot of
45:25percent look forward to severely.
45:27Great to hear this.
45:29Next up is Doctor Terrasanta.
45:31Give us an update on survivorship.
45:35Thank you doctor Hooja.
45:41I'd like to just remind everyone
45:44that we have a very large.
45:47Survivorship network,
45:48here at throughout the Smilow Cancer
45:52network we have survivorship programs
45:54not just in Smilow New Haven,
45:58but also at L&M.
46:01Bridgeport Hospital Greenwich Hospital
46:04an multiple survivorship support staff
46:07and providers all across our network.
46:10We also have supportive care services as
46:13mentioned by Kim and Kevin and some that are,
46:16you know, highly utilized by our survivors
46:20like the sexuality and Intimacy Clinic.
46:23The cardio oncology clinic.
46:26Oncology rehab and we have a new
46:29cancer and cognition clinic.
46:31Anna supplements clinic and we work
46:33very closely with our palliative
46:35care and integrative medicine
46:36colleagues so I just want to call
46:39out all of you on the call today.
46:41You were involved in the
46:43survivorship network and thank you.
46:45National Cancer Survivors
46:46Day is an annual event,
46:48usually the first Sunday in June and
46:51last year we converted to a virtual event
46:54and it was actually wildly successful.
46:58We had thousands of views on our website.
47:02And what we are doing again this
47:05year is something similar and I
47:07hope that with a little bit more
47:09preparation all of you can participate.
47:12So what we're doing is a sort of a
47:16month of June theme of myth busting
47:21different survivorship type myths,
47:23and we're hoping to have many
47:28people contribute short videos
47:30celebratory messages to survivors,
47:33messages of gratitude or tips and tricks
47:37that reflect your area of expertise.
47:41Really,
47:41it's a it can be anything.
47:44That you wanted to submit short
47:46videos from yourself or your team.
47:48You can email cancer answers at
47:52yale.edu and Renee or Emily will send
47:55you a link to upload your video.
47:58Well,
47:58there's also room for testimonials from
48:01survivors if you're interested in that,
48:03you can also email cancer answers
48:05at yale.edu.
48:06We're sharing through social media
48:09under the hashtag smilow celebrates.
48:12And then we're posting these sprinkled
48:15throughout the next few weeks in June,
48:18in various different themed weeks,
48:22and then we'll sprinkle in
48:23the messages of gratitude.
48:24So please, if you're on this, call Ann.
48:27You're at all interested.
48:29Send a video through cancer
48:31answers at yale.edu,
48:32or patients really want to see you and
48:35they feel very close to their teams
48:38when they see these videos posted.
48:40In addition,
48:41we thought would be really fun to
48:43capitalize on the Smiler shares
48:45format that I was born out of,
48:47COVID that patients are able to respond
48:50to and and tune into in real time.
48:53So every Tuesday at 7:00 PM
48:55we will have a smile,
48:57oh shares and we are highlighting
49:00these various programs all across
49:02our network with experts again from
49:05top to bottom of our geographic area.
49:08So next week we will talk about.
49:10Exercise and strength for cancer
49:13survivors and then June 15th sexuality
49:16intimacy and menopause in cancer survivors.
49:19June 22nd supplements and Nutrition and
49:23June 29th holistic coping strategies.
49:26This will be a mix of experts talking
49:29about myths within these topics,
49:32and then some panelists to answer questions.
49:35You're welcome to join us as well,
49:37but please feel free to pass
49:39this along to your patients.
49:43I wanna just take this one last
49:45moment to put in a plug for our
49:48series on emotional intelligence.
49:49This is open to all members of the cancer
49:54community and it's been very popular.
49:57It's hosted by Marc Brackett and
49:59Robin Stern from the center of
50:01Emotional Intelligence here at Yale,
50:03we've had two sessions an our
50:05next session will be Monday,
50:08June 21st at noon and this is
50:11more about our own health.
50:13And taking care of ourselves and
50:15each other an I think we've learned
50:18a lot in the pandemic on how
50:20important that is now more than ever.
50:23So if you're interested in this,
50:25please feel free to email me if
50:27you're not already on the distribution
50:28list and we'll get you the invite.
50:30Thank you.
50:32Thanks Doctor Sampson, I love the
50:34idea of uploading those little videos.
50:36That is phenomenal.
50:37We have a V amazingly finished.
50:40We have a few minutes so you all did
50:43great and we have a few minutes for Q&A,
50:46so hopefully all folks can
50:49time in their questions.
50:52Come to our panelists,
50:53'cause I think in the other piece I
50:55wanted to mention is we do have a
50:57patient symposium in our last one had
50:59a really nice turn out to be continued.
51:02This based on the events during
51:05COVID and had nice sort of
51:08interactions with our patients.
51:10Perhaps as folks are
51:12typing in their questions,
51:13I'm going to ask something to either
51:15Doctor Gruber, doctor Eva sake.
51:16One of the questions that came up and
51:19I have to say Kevin Billingsley did
51:21a really nice job, but I'm not sure.
51:23I'm convinced that I knew the answer, but.
51:25Our immuno suppressed patients
51:27who get vaccinated.
51:28There seems to be even on CNN this morning.
51:32There's a lot that are be
51:34producing enough antibodies.
51:35What should we be sort of thinking about?
51:37What's the current state of affairs on that?
51:42And I knew if it's like I'm not
51:43going to give you the easy ones.
51:47Yeah Kevin, do you wanna go well?
51:51Capital. In front of
51:54a world class immunologist.
51:59What I think we're counseling
52:00patients is that for.
52:04People who were on lymphocyte
52:07depleting therapies,
52:08and we know that their the their immunity,
52:13immunological response to vaccination
52:15is going to be blunted related either to
52:19the disease process or to the treatment
52:22that it is prudent to work closely with.
52:26Your treating oncologist and potentially
52:29delay vaccination until there has
52:32been some immune system recovery.
52:35For people who were heading into bone
52:37marrow transplant stem cell transplant,
52:39we're obviously trying to get them vaccinated
52:42before they embark on that treatment.
52:45Unless they're having a rapidly
52:48progressive acute leukemia or some
52:51hematol other haematological malignancy.
52:54What I am kind of trying to
52:56communicate to the public is that
52:58that is a really actually relative,
53:01quite quite a small population
53:03of cancer patients.
53:04Given the broad pool of people
53:07that we treat and smilow,
53:09and for the vast majority of our patients.
53:13Vaccination is perfectly safe.
53:15They should be vaccinated, and they will.
53:19They'll mount a protective immune response,
53:22but. I think akeel let me have you.
53:26You can fill us in on the real science
53:27you passed or not.
53:32No, I think that's a perfect answer.
53:35I was also going to add,
53:36you know if it's possible to use
53:40monoclonal antibody cocktails on some of
53:42the patients who are very vulnerable.
53:44You know, I don't know if that's
53:45going to be approved for use,
53:47but that's something to be
53:49thinking about in the future,
53:51because these monoclonals they can last for,
53:53you, know sometime at least,
53:55to prevent infection of these
53:57email compromised people.
54:01This is Ken. I was just gonna
54:02say last week we did host
54:04Milo hosted a town hall.
54:06I'm hoping maybe we can check with
54:08Renee to see if it was recorded
54:10and maybe we can follow up with
54:12our community on where that's at.
54:13'cause we did host a immuno vaccination
54:17and immuno compromised patients
54:20town hall last week with with
54:23several several faculty members from
54:27infectious disease and and smile oh so.
54:31Renee saying yes,
54:32it was recorded show host in the link.
54:35There was great discussion in
54:37that town hall last week as well.
54:39Thank you Doctor Grubaugh a
54:42question for you in the chat.
54:45Have you seen vaccine breakthroughs
54:46yet in Connecticut or New Haven?
54:50Yeah, there's been hundreds of vaccine
54:52breakthroughs than Connecticut so far,
54:55and I think you know,
54:56that should have been expected going in
54:58that it's the the vaccine is not 100%.
55:02What we're finding in?
55:03We're finding this from, you know,
55:05other individuals from or other groups
55:07from all over the country is that we're
55:10not really seeing a over representation
55:12of 1 variant in the vaccine breakthroughs
55:15versus the unvaccinated population.
55:16Not saying it it may not stay that way.
55:19There may be things that emerge or with
55:21more data, we end up finding things,
55:23but so far it seems to be what what people,
55:26what causes?
55:27Vaccine breakthroughs are just.
55:30The same things that caused
55:31all other infections,
55:32and it probably means that it has
55:34more to do with the host response
55:35than it does the virus itself.
55:38Thank you so much and I
55:40think that's reassuring.
55:41I mean, some are expected,
55:42but I'm glad to see that that you know,
55:45we're not seeing a particular
55:47variant breakthrough.
55:47The next question I have here is,
55:50and perhaps because we sit on two sides,
55:54maybe Kim and Kevin.
55:55You can tackle this.
55:56What are the panelists?
55:58Thoughts on getting back to
55:59small in person meetings versus
56:01zoom in regards to connection,
56:03communication and productivity?
56:11I.
56:13I guess I will say that I think we are
56:16at a juncture in our evolution through
56:19this that we do have support from,
56:22at least on the health system side.
56:26To gather in small meetings.
56:31And in our workspaces,
56:33not in clinical care spaces.
56:38For for business related activity.
56:42Ink. And those of us who are
56:45on the leadership team are
56:47starting to do that.
56:47And I do think that it.
56:50Is is productive?
56:51I will say that I don't.
56:54I have not heard where the
56:56School of Medicine sits.
56:58On that policy directly.
57:05Kim, do you want to add anything else or no?
57:08I agree with Kevin.
57:09I mean I think we I saw Roy's
57:12pictures of some outings and so forth.
57:14So it looks like there's.
57:15I think you know the outdoors.
57:17If we can utilize the warmer weather and but,
57:20but I know that connection is so important.
57:24So I think as long as we start
57:26small and as Kevin said,
57:27there are some health system guide
57:29guidelines that have allowed us to start
57:32coming together a little bit, not in.
57:34Big groups, but in small meetings and
57:38non clinical areas and I think I I
57:41think we should be supporting our teams
57:43together like that when when we can.
57:46I think we have learned that zoom
57:49really helps us as well so I think we'll
57:52probably just like Tele health, right?
57:53Well, always live in this hybrid
57:56world but I think all of us would
57:59love to see more in person.
58:03Time together
58:04and I know Roy you have your
58:05hand up from the university.
58:07As you know the guidelines still
58:09stand in terms of yes you can
58:11meet its their size limitations.
58:12You need approval for certain events
58:15and then the most biggest caveat
58:17is consumption of food is still not
58:20allowed on the university campus.
58:22So again that may change and I
58:23know they are looking to change
58:25as you're seeing that from the
58:27Provost Doctor Hurts you.
58:28Had your hand up.
58:29Yeah, I just wanted to say that we
58:30found all the rules and we're meeting
58:33that we are. Paying for it ourselves,
58:34and we're not doing any official events.
58:36We have to follow the guidelines, but you
58:39know there's nothing wrong with someone
58:40having a party and you go to it.
58:44OK, well it's the top of the hour,
58:46so I think Renee wanted me to remind Renee.
58:49Do you have one?
58:50Thank you to all our panelists for
58:51presenting and for keeping to the time limit.
58:53I really, truly appreciate it.
58:55We made it. And then there's going
58:57to be a brief survey at the end
58:59of today's town hall webinar.
59:00I think it pops up as as the web and
59:03R finishes and then the other part is
59:06if you have other ideas or questions.
59:09Cancer answers at yale.edu just submit
59:11them and we will try to address those.
59:14So again, same same time next
59:16month first Thursdays, 5:00 PM.
59:18See you then thank you everybody
59:19have a good evening.
59:23Thank you.