Mayo Clinic's coronavirus research task force is in a desperate race against time

Like the rest of the world, the Mayo Clinic's Dr. Andrew Badley hadn't heard of the deadly virus scientists refer to as SARS-CoV-2 until reports emerged from China in December. But it was as if his nearly four decades as an infectious disease specialist had prepared him for this moment.

Now Badley, a 55-year-old HIV research specialist as comfortable in the lab as he is bedside in a clinic, chairs the Mayo Clinic's novel coronavirus research task force, an urgent operation that is quite literally all hands on deck.

The budget? In a time of austerity, that's a complicated question — but he has Mayo's full support for researchers and talent. The timeline? As fast as scientifically possible.

When the Mayo Clinic — one of the world's top research hospitals, with more than 4,000 full-time research personnel — tapped Badley to lead the task force that approves COVID-19 research proposals, he became the lead of one of the most aspirational projects in medicine. More than half of Mayo's research staff is working on coronavirus-related projects.

"Mayo can do big things," said Dr. James Cerhan, a Mayo epidemiologist on Badley's task force. "But this is once in a generation, once in 100 years, that we've had to organize like this so fast, both on the clinical and research sides."

When Vice President Mike Pence visited Mayo last week, Badley was part of his tour, explaining Mayo's portfolio of COVID research projects. He told the vice president the scientific world is in a much better place with COVID-19 than in the early days of HIV, when it took months to find the virus, years to understand the viral proteins and more than a decade to create drugs that target those proteins. With COVID-19, the virus was identified within weeks, and roughly 800 clinical trials are already underway worldwide for potential therapies.

In a career dedicated to fighting one of history's most destructive pandemics — HIV has killed some 32 million worldwide to date — Badley's life since mid-March has felt like a scientific déjà vu: a new path strikingly similar to one he's trod before, only with a much accelerated pace.

"From day one we were being inundated with ideas," Badley said. "The interest and dedication and outpouring of thought and ideas in the scientific community — within Mayo and around the globe — is stunning."

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On the fifth floor of Mayo's nearly century-old Plummer Building in Rochester, this ambitious project has taken shape over the past seven weeks. Think of it as Mayo's pandemic version of the Manhattan Project, the World War II effort to build the first atomic bomb: a sudden and relentless race against time, with scientists furiously researching as millions of lives around the world hang in the balance.

Badley holes up in a conference room alongside his co-chair, Amanda Mikhail, an operations administrator in research — the business-side yin to Badley's scientific yang. Two whiteboards are filled with Mayo's active COVID-19 drug trials; Mayo, with pharmaceutical partners, has already activated or will soon activate nine separate COVID-19 drug trials. They've pored over more than 500 research proposals and approved, as of last week, 109, ranging from ideas for vaccines to studies on how certain populations combat the virus, from ways to recycle masks to ways to better provide oxygen to patients, from research on community response to studies on outcomes of recovered patients.

This war room is the first point of contact for proposals — Mayo physicians and researchers were told in March to e-mail ideas directly to the duo — and where the research is ultimately approved. But approval comes only after passing through experts in each field.

"Nothing at Mayo happens with just one person," Badley said.

The work is equal parts exhausting and invigorating. Coffee cups and PowerBar wrappers overflow the wastebasket alongside takeout containers; roast beef and Gouda sandwiches from Rochester's City Market are lunch staples.

"It's kind of like air traffic control in a blizzard," said Mikhail, the co-chair. "It has to be very, very precise, the things we're doing and bringing to our patients, yet it's coming at us from so many different angles."

Badley has constructed 16 independent, parallel working groups, filled with subject matter experts in each field, who review proposals. He connects researchers across specialties who have submitted related research proposals. The goal is to rigorously follow the scientific process, but to do so as quickly as possible. Steps to approve a clinical trial were once sequential but are now parallel, and clinical trials can go from an idea to activated in days.

"It took a decade-plus for good HIV drugs," Badley said. "I believe we can get good drugs for COVID certainly within a year, possibly sooner."

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HIV and the novel coronavirus are "almost superimposable Venn diagrams," Badley said. "If you take a step back and ask, 'How is it an infection harms a human body?' It's not because you have the virus in you. It's because your body reacts to having that virus in you."

Many scientific leaders in the coronavirus battle — such as Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases — came of age through cutting-edge research into the human immunodeficiency virus that once confounded clinicians and researchers. That was Badley's path, from the dark days of the 1980s, when many of his patients died each week, to the joyful days of the late 1990s, when therapeutic breakthroughs turned a corner on the virus that still has not been eradicated but that Badley now calls a "chronic manageable condition."

Growing up in rural Nova Scotia, Badley swore he'd never follow in the footsteps of his gastroenterologist father. But when he went to an infectious disease seminar as a teen in the early 1980s, a physician spoke about his experience in Africa treating a new disease called HIV, which had yet to proliferate in North America. Badley heard about the high rate of illness and death and the increasing number of orphans. The doctor predicted it would spread globally.

"I was terrified, absolutely terrified — for people, for myself, for the planet," Badley said. That moment led Badley to study immunology and virology, graduating from medical school at Dalhousie University in Halifax before heading to Rochester for his residency at the Mayo Clinic School of Graduate Medical Education.

For Badley, it became less a job, more a calling. Early in the epidemic came a defining moment. A new patient was in advanced stages of AIDS. Badley felt helpless, unable to offer hope against a virus the scientific community knew little about. The patient died in isolation. The moment clarified the disease's terrifying outcomes and the urgency of Badley's mission.

He was also there for the breakthroughs. In the late 1990s he was at a University of Ottawa center that had early access to protease inhibitors, one of the first successful HIV drugs. Deaths dropped. Sick patients became healthy six or nine months after starting on the drug regimen.

"When the number of cases in our clinic started to drop, it was profound," Badley said. "Virus replication went down, the immune system got better, the patient felt better. Optimism, enthusiasm, absolute joy."

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Badley doesn't like to sit still. A friend called him "twitchy." He loves fishing, but only fly fishing, an all-consuming distraction where he's reading the water and air conditions, choosing between wet flies or dry flies or nymphs, calculating where to place the fly and how to present it. He keeps a hobby farm in Byron, but it's not just a place to get away from the world; one recent evening just before sundown, Badley picked up his phone while tending to his bees.

Every weekend since the task force formed, his colleague and friend Dr. Patrick Dean has forced Badley to decompress for a couple hours of fly fishing at streams in Minnesota or northeast Iowa — places without cellphone service. (The doctors wear masks and gloves in Dean's 20-year-old Chevy Tahoe.)

The first weekend, Badley, overwhelmed by it all, just sat on the bank and watched the world go by. By a recent weekend, he'd returned to his active self, catching a dozen or so fish and throwing them back.

"If you had to pick one person to be stranded on a desert island with, it'd be Andrew," said Dean, who goes on annual South Dakota pheasant hunts with Badley and his bird dog, a Vizsla named Dexter. "He can build a house, harvest game and cook that game."

Those varied interests are vital to the COVID-19 team's approach. Badley sees one of his roles as getting researchers out of their silos to work across specialties with researchers pursuing similar proposals.

Colleague John O'Horo remembered early on when they reached a bottleneck. One chemical — a viral transport medium that gets samples off swabs and into testing machines — was back-ordered. O'Horo worried they may have to ramp down testing just as they were ramping it up.

Instead, Badley e-mailed a couple dozen microbiologists and asked about a substitute for the chemical. For a couple hours, e-mails flew back and forth until the microbiologists came up with an adequate replacement. Bottleneck averted.

"We have a rare thing where almost everybody in this institution is pulling toward the same projects in the same areas," O'Horo said. "That's moved things at an incredible rate."

Success will come in multiple ways. Short term, Badley hopes to access promising experimental therapies for COVID-19 patients — and soon. Confidential information he's seen from ongoing studies fuels an optimism that there will be effective drugs identified within a few months. Long term, he hopes for two things: that Mayo researchers can continue this momentum, and that awareness of public health's importance brings increased funding on a national and global scale.

"It's a truly remarkable alignment of forces," Badley said. "A friend of mine told me that in times of crisis your personality is amplified, and I think that's absolutely true. The number of good people doing great things now is stunning."