On the inaugural episode of In Pursuit, host Patrick Seed, MD, PhD, tackles the topic of infectious diseases with Larry Kociolek, MD. Kociolek is a born-and-raised Chicagoan and a physician-scientist at Stanley Manne Research Institute at Ann & Robert H. Lurie Children’s Hospital of Chicago. He is dedicated to understanding the spread of microbes in community and healthcare settings and tackling the big research questions that might change how we keep patients safer in the hospital from infectious complications.
Host: Patrick C. Seed, MD, PhD, FIDSA, Attending Physician, Infectious Disease; President & Chief Research Officer, Stanley Manne Children’s Research Institute; Children’s Research Fund Chair in Basic Science; Professor of Pediatrics (Infectious Disease) and Microbiology-Immunology, Northwestern University Feinberg School of Medicine
Guest: Larry K. Kociolek, MD, MSCI, Attending Physician, Infectious Diseases; Medical Director, Infection Prevention and Control; Irene Heinz Given and John La Porte Given Professorship in Pediatrics; Associate Professor of Pediatrics, Northwestern University Feinberg School of Medicine
He is dedicated to understanding the spread of microbes in community and healthcare settings and tackling the big research questions that might change how we keep patients safer in the hospital from infectious complications.
Show Notes
A Background in Infectious Disease Research
Kociolek’s details his clinical and research background which began with the idea of improving the safety and the quality of healthcare by preventing infections in kids who are in the hospital.
The Power of Microbes
Seed and Kociolek discuss how people have become even more fearful of microbes since the COVID-19 pandemic and why it is important to acknowledge this fear but try not to make decisions based on fear.
COVID Research Contributions from Stanley Manne Investigators
There was a myth that persisted during the COVID-19 pandemic that kids were not being impacted by the virus. While they were not dying at the same rate as adults, Kociolek says they were greatly impacted. He discusses his contribution to helping Chicago Public Schools investigate how much transmission was occurring among students and teachers and putting highly effective mitigations in place.
The Future of Infection Prevention
Kociolek says access to microbial sequencing that has come out of academic centers and public health partnerships is helping scientists better understand organisms, such as new variants of COVID-19. He highlights important wastewater surveillance projects taking place in New York and Chicago to identify likely unrecognized circulation of polio virus and mpox. He is also excited about a new pilot project from the Chicago Department of Public Health that uses devices to pull air in from certain environments and collect pathogens that are in the air and identify the emergence of respiratory viruses with substantial public health relevance like measles. The Lurie Children’s emergency room will be one site for this project. “What better place than a pediatric emergency department to understand the spectrum of respiratory illness?”
Chicago Ties
Raised on the southwest side of Chicago, Kociolek has a large family in the city and deep ties to the community. He says it gives him a lot of satisfaction to be so involved in efforts to keep children in Chicago safe from infectious diseases.
Read the Transcript
Patrick Seed, MD, PhD [00:00:02] This is In Pursuit, research perspectives from Ann & Robert H. Lurie, Children's Hospital of Chicago. I am your host, Dr. Patrick Seed, President and Chief Research Officer of Stanley Manne Children's Research Institute, one of the nation's largest freestanding pediatric research centers. I'm excited for you to be listening in for our inaugural edition of In Pursuit and to have our first guest, Dr. Larry Kociolek. Larry is an attending physician for infectious diseases at Lurie Children's. He served as the hospital's medical director for infection prevention and control and recently was named the vice president of System Preparedness, Prevention and Response. In academics we also like to give our talented and notable faculty members nice named titles. So Larry also holds the Irene Heinz Given and John La Porte Given professorship in pediatrics at Lurie Children's, and he's an associate professor of pediatrics at Northwestern University Feinberg School of Medicine. I wanted to get Larry on the podcast to talk about how we think about the spread of microbes in the hospital and the big research questions that might change how we keep patients safer in the hospital from infectious complications. Of course, as much as we sometimes want to avoid the topic, we'll probably touch a little bit on COVID-19 and the pandemic and how it shaped some of our ideas around this topic. It's pretty hard to avoid nowadays. I also want to add that Larry has Chicago baked into him through and through. And so I hope we'll get a chance to talk a little bit about how Chicago shaped how Larry has got to where he is and his perspectives on the impact of big infectious events like the last pandemic in a place like Chicago. Larry, welcome to the podcast and thanks so much for agreeing to be our first guest.
Larry Kociolek, MD [00:01:45] Thanks so much, Pat.
Patrick Seed, MD, PhD [00:01:46] So, Larry, if you just start by giving our listeners a little perspective on your role at Lurie Children's, I know it has a lot of facets to it. You've had a pretty high visibility position over the past years as the medical director for Infection Prevention and Control. While we were all trying to navigate the COVID-19 pandemic. And I also know that you're leading a new endeavor at Lurie, so we'd love to hear about that.
Larry Kociolek, MD [00:02:07] And we're a lot of hats here at Lurie Children's, and I'm fortunate to be able to do what a lot of people sometimes can't is wear a lot of those hats at the same time. A lot of the work I do administratively, clinically and from a research standpoint, all has direct interaction and overlap. And many scientists, oftentimes, particularly in infectious diseases, fall in love with a certain pathogen or a certain bug or a certain technique and really hone in on one particular aspect for their career and become world changing in that regard. My approach to research has been a little bit different, where I've wanted to focus more on developing a research skill set, a toolbox that allows me to address needs as they present and pivot or refocus or expand as these threats change over time. When I joined Lurie Children's, I was very interested in improving the safety and the quality of health care by preventing infections in kids who are in the hospital. There's a whole lot of things I could have chosen, and I settled on Clostridium difficile infection or C diff because that was one of the biggest threats that I saw impacting the care of children in the hospital. And so I acquired a skill set that allowed me to do very sensitive and high tech techniques of essentially fingerprinting bacteria that were causing infections in children in our hospital. I use that backdrop of hospital infection prevention and control to provide a laboratory, collaborated with individuals here at Northwestern and at other institutions to be able to essentially fingerprint bacteria and identify the transmission pathways for kids. If we understand how children become infected, we then can develop strategies, sometimes new strategies, sometimes existing strategies that we do apply in the right context, to prevent those infections. Answering those questions led to more questions. More answers also required more collaborators, because I found that much of what I wanted to answer was outside of the toolbox that I've developed. And I think that really speaks to the concept of teamwork, of networking, the importance of having peers in your field, the importance of knowing the limitations of what you can and cannot do yourself, and the strength of those collaborations in obtaining grant funding and answer the most pressing questions in our field.
Patrick Seed, MD, PhD [00:04:24] Let me explore this a little bit because I think the pandemic's done a lot of things. I think that's underestimated statement for people and people have different perspectives. But I think one thing is that's really shown people the power of microbes where it's both the severity of illness or the mystery of why some people don't get sick with microbes and the ability for these things to spread across the world. It's grown a whole mindset for a lot of people of fear about microbes, right, Particularly in places like hospital environments where people now identify those as sort of places that could breed or foster infections and things. I'm curious just to take your sort of level view of what makes you jump out of bed in the morning and gets you really excited about the opportunities?
Larry Kociolek, MD [00:05:12] As I was entering this field, I remember listening to mentors and people that have been doing this for a long time and was always impressed about what they were expert at now was something that didn't even exist at the beginning of the career. And the classic pathogen is HIV, which completely changed all aspects of medicine in science and but also politics and, you know, sociology and all these other aspects that would be seemingly outside of medicine. For us in our generation I think COVID is that pathogen that has had that impact. I have been fortunate to have had a front row seat for this and to use my research skills in my administrative skills in COVID-19 to not only implement research rapidly, to understand the impact of children, but to also use what I was learning in real time to educate people in the hospital that were quite fearful to come. I mean, if you're a health care worker in the midst of a respiratory viral pandemic, there is a threat at your workplace every single day. And so I had to be someone who was appropriately conservative, but also someone who understood the backdrop of that fear, that uncertainty, that anxiety, to ensure that the mitigations that we were taken were not only appropriate from a staff safety standpoint, but also acknowledge the uncertainty and also to have the courage to speak up when things perhaps weren't necessary or we did not think we're going to provide a high level of safety. Certainly a lot of those issues have come up about appropriate use of masks and appropriate use of remote schooling and kids. You know, these are questions that I think will be debated for a long, long time. The fact is, during the course of the pandemic, we needed to be honest, conservative and skeptical all at the same time, which is sometimes difficult to do. And so looking forward, I think we've learned a lot about things that we were prepared to do and well-prepared to do and in things that demonstrated real challenges for addressing the next pandemic. That includes having infrastructure in place to allow academic hospitals to pivot and focus research resources in real time on an emerging threat. Having the appropriate community leaders engaged in that and experts in communication who will allow us to speak a understandable language and translate research findings in real time to help people understand their risks. It's taught us that while understanding and acknowledging that fear that we need to try not to make decisions based on fear and to appropriately inform individuals of real risks and ensuring that they have appropriate understanding of the mitigations that we're taking, the benefit that we think they provide, and also the uncertainty that's present in how we're going to navigate that uncertainty, to continue to modify our practices to keep people safe.
Patrick Seed, MD, PhD [00:08:21] And then the flip side, what are the things that keep you staring at the ceiling at night now in the backdrop of, you know, what has really been this massive event for people recently.
Larry Kociolek, MD [00:08:32] In our field, there's so many challenges in pediatric health that there's, quite frankly, a lot of stuff that can keep us up at night. With my role in preparedness, prevention and response, my goal is to have our health care facility, our health care staff and our communities be ready to address any challenge that they have that's going to interrupt our ability to have health care and participating in the activities necessary for functioning in society, be it jobs or school or social activities. I think the threat of another pandemic from a respiratory route is very real. Certainly the emergence of pathogens in parts of the world that that have incredibly high mortality rates is a concern. But the way that those pathogens travel like viral hemorrhagic fevers, for example, and the public health infrastructure that we've built, I think we'll do a pretty good job to allow the global public health infrastructure to be able to stop those threats in fairly real time. But the fact that respiratory viruses cause such a wide spectrum of disease that they're so transmissible and that global travel is so pervasive that I think those are the things that are going to continue to keep me up at night. While COVID-19 was a once in a century pandemic, I don't I don't think it's going to be another century before the next respiratory virus pandemic. Just in my career alone, since I started medicine, we've had three novel coronaviruses that have emerged. We are oftentimes identifying new influenza viruses that have the potential to cause a human disease with new mutations. And while we've recovered from the COVID-19 pandemic, in a lot of respects, we don't have the same level of preparedness in all corners of our country. And that leaves a lot of communities vulnerable. We have a lot of work to do. I don't want to see us put COVID-19 in the rearview mirror. I think we need to have it in our vision, appropriately acknowledge it, and use it as a celebration of our success, but also a reminder that we have to continue to have some mitigations present, to continue to protect people in our communities, and also as a reminder that we need continual investment in public health infrastructure and other necessary resources in our communities to be able to respond more quickly and more equitably in the future.
Patrick Seed, MD, PhD [00:10:50] So many problems and challenges in that had to be learned in real time, but were fortunately leaning on past experiences of other health care challenges you alluded to. HIV is an example, but we've seen epidemics and other things that have provided some basis going into this. To our researchers in this whole equation I think it's so front and center in not only obvious but important to recognize what our health care workers did as you described on the front line and really often running into fire, so to speak. Very early on, we forget. We really didn't understand what this virus, this pathogen was capable of doing. And so we didn't know how to fully protect ourselves or we had good estimates. But there was debates about it. You know, during that time, our researchers were really pretty busy during the pandemic. And I wanted to just ask you what you thought some of the big contributions our investigators, including yourselves, made to understanding the pandemic and how that led to some of the best evidence that emerged from that work and sort of provided some guiding light for us.
Larry Kociolek, MD [00:11:54] The challenges both in science and medicine that HIV presented. But a lot of the other challenges that that had to do with, you know, education in politics and global health and a lot of things that aren't directly impacting a patient in the bedside in the U.S., for example, at that time in COVID, I think, demonstrated the breadth of challenges in health care and community health and aspects outside of health care, like public education and use of technology for communicating and things like that. And our institution took a lead in all of these areas. I guess my proudest contribution of my research program was working with large school districts in Chicago. We knew that having children outside of the classroom is not an ideal instructional environment, but it was absolutely necessary at the outset of the pandemic until we had an understanding of how schools are going to serve as a vector of disease amplification. Once we understood the effectiveness of our mitigations, these were implemented in schools with really high success. And, you know, we were able to partner with schools and go into schools and look to see how much transmission is occurring among students and teachers. When these mitigations were in place. And we demonstrated quite convincingly that those mitigations were highly effective. That was really important to demonstrate because you had a lot of individuals that were debating about whether kids should be in school at all, if they should be in school, are we appropriately using mitigations? And I think being able to do those studies and provide that feedback back to Chicago Public Schools, which were very large school districts with children from underserved populations whose communities were destroyed by COVID-19, that was really important to do. But that's just a very small aspect of our COVID-19 research achievements. During that time, we had individuals doing health equity work where we took a really deep dive into their thoughts and feelings behind the pandemic in terms of how it impacted their communities, how the mental health needs of communities and populations are impacted by a global public health crisis. How individuals from resource poor areas are able to access good information, How are they able to access vaccines in other countermeasures for COVID-19. We also participated in clinical trials to understand how medications can be appropriately used in pediatric populations. That was very, very important is we remember very early on the pandemic, there was a statement that was pervasive throughout our field, and that was kids are not being impacted by COVID-19, and it was blatantly false. Kids were not dying at the same rate of adults from COVID-19. That remains true. But kids were certainly impacted by this pandemic in a lot of ways. But because of that myth that that fallacy and logic, a lot of the studies on vaccines and other medical countermeasures were really focused in adult populations. And so having pediatric hospitals step up and taking on these clinical trials is really important. It's a challenge of implementing this research in the midst of a public health emergency, dollars in infrastructure for good reason aren't maintained just to have at our disposal to only deploy in the case of an emergency, we need to use that infrastructure to address all of the other pressing health care needs in kids. And we can't just pause work on other really important aspects of pediatric medical science to focus. But we were able to identify opportunities where because of differences in our care model and different needs of some staffing in other areas, we were able to deploy them to have them assist with research studies. And so having the forethought about how we can redirect resources, how we can quickly just reorder our priorities and have a process for continuing to revisit those as the needs of a pandemic changes.
Patrick Seed, MD, PhD [00:16:02] It's just such a reminder of the incredible depth and breadth. You know, usually we talk about people being focused and really working hard on single problems and things, but it just necessitated everybody going really broad and going deep, like you had to do both. And it showed really, I think, the really incredible capacity of all the teams that we have to do the research. I also was sort of snickering here on my end a little bit, Larry, because I was thinking about also the MacGyver moments early on. You forget about the supply chain problems and we were directing so much of our supply that we had towards clinical activities, which totally made sense, right? We had patients coming in sick and we had to take care of them. But I think about all the plastic where like getting pipette tips or the viral media, right, that you need to collect samples to even start to develop the assays because we forget at the beginning we didn't have good tests, right? We were sort of doing those in the research labs to even figure out how to test for SARS-CoV-2, the virus for the COVID-19 pandemic. Tell me what you see in the future coming in infection prevention, particularly think about the health care environment specifically.
Larry Kociolek, MD [00:17:09] That's a really great question. And I think about this a lot in terms of how we can look back and leverage our experience to come out of this better than when we started. You know, I tend to be a fairly optimistic person. I try to find the silver lining in the pandemic. And I think one of the most important things for health care, public health epidemiology and medical science is the wide access of microbial sequencing that has come out of investment in academic center and public health partnerships. Microbial sequencing, taking a virus or a bacterium, a fungus, whatever we're looking at and sequencing their full genome allows us to learn so much about that organism. And oftentimes in real time, where public health bodies across the country are now able to tell you the exact variants that are causing COVID predominantly in their population with exquisite sensitivity and specificity on that. But now it's been learned that we can look at other public reservoirs to be able to predict this in real time. And so, you know, for example, the case of polio in New York, that happened within the last year, we've learned a lot through wastewater surveillance. We know that polio virus is excreted in large quantities in stool. And so in the city of New York has been able to map areas and identify likely unrecognized circulation of polio virus. So that's very, very important. And we can do that really in any jurisdiction in the city of Chicago is doing that. And they use that for mpox, they used it for COVID-19. They're looking to do that for polio as well to help us predict infections. Theoretically, we could do that for air sampling as well. Right now, the Chicago Department of Public Health is participating in a pilot. They have these devices which pull air in from certain environments and collect pathogens that are in the air in a fairly regular basis. What they will be doing is sequencing of the cartridges from this device to try to identify what's circulating in communities and predict it. We're going to pilot that technology in our emergency department. What better place than a pediatric emergency department to understand the spectrum of respiratory illness. They'll place these in other strategic areas as well, like public transportation depots or other public areas. And that will help us to be able to identify emergence of respiratory viruses with substantial public health relevance like measles. And so I think the novelty of being able to take a really deep dive into these public reservoirs and add microbial sequencing technology to those public health activities will provide us so much better ability to predict and monitor and respond in the future.
Patrick Seed, MD, PhD [00:19:45] Yeah, it's amazing. I mean, I just think about the renaissance we're in, you know, in terms of some of these these molecular tools and to think that we can take something that was sort of the inception and single labs and start to employ it out in these broad, geographically distributed and community spaces is pretty amazing in a pretty short amount of time. And then of course all the AI and the ability to then leverage computational power to sort of then predict where trouble's brewing and not whether it's in a big place like a city or it's in individual kids who walk through our emergency room to to your point. So you grew up here in Chicago and have a pretty sizable family that keeps fairly close on the southwest side. How does your Chicago environment, do you think, motivate you or change you as a physician scientist?
Larry Kociolek, MD [00:20:33] That's a great question, and you're correct. My family quite close and very few of my relatives have left the Chicago area. I left temporarily and came back and wanted to come back because of my relationships. Now I'm the first person in my family to have graduated from a four year college, first person with a bachelor's degree. And so I didn't have anyone that was in the science field or medical field. My influence from my family wasn't medical or science per se, but it was about relationships and care for others with challenges. And so my mom raised us for quite a long time. And then when I got into high school, went and got an associate's degree in special education and became a paraprofessional for 20 years and recently retired from that. And I learned so much from my mom about her care of children with special needs and describe her work with their families, and how having advocates assist special needs children and their families with navigating the challenges that they have both inside and outside of the classroom always spoke to me. I think that is probably the most important aspect that drove me into a field that wanted to provide care to a whole lot of people. And so don't get me wrong, I love medicine in the focus on one person, but what really drives me to come to work every single day is the public health component of what we do and how I can be an advocate, a source of truth, a source of education for a lot more people than than just the patient who may be caring for that day. Being in Chicago itself and having so much pride in my city and where I grew up in the people in the communities that we serve has given me a lot of satisfaction to be really well integrated with the Chicago Department of Public Health in terms of our preparedness and response efforts, be it responding to something like COVID-19 or Ebola or just working on our everyday threats like RSV and influenza. That interaction, that close tie to the individuals in our city that are tasked with keeping everyone safe in our communities. And I think it's noble, it's fun, it's a unique challenge. And being able to integrate that with our clinical care models here has been quite gratifying.
Patrick Seed, MD, PhD [00:22:44] Larry, I just want to thank you so much for joining me today. I think it's been a really enlightening conversation and I know our listeners will really enjoy hearing from you.
Larry Kociolek, MD [00:22:54] Thanks so much, Pat.
Patrick Seed, MD, PhD [00:22:57] For more information on Stanley Manne Children's Research Institute at the Ann & Robert H. Lurie Children's Hospital of Chicago, visit our website research.luriechildrens.org.
