Dr. Michael Fralick – A COVID-19 Research Pivot
September 6, 2020
By Krista Lamb
For many clinician-scientists, COVID-19 has meant closing their labs and shutting down their research programs. Some have been reassigned to COVID projects and others have simply concentrated on their practice.
BBDC researcher, Dr. Michael Fralick, made the decision to take on new challenges during the pandemic—using the skills he had acquired in his research and his practice as a general internist to begin work on several promising COVID-19 studies.
Fralick’s pre-COVID research focused on population-based databases and the safety of new diabetes medications. He was particularly interested in SGLT2 inhibitors for the treatment of type 2 diabetes. In particular, he used machine learning and artificial intelligence to predict adverse outcomes among people hospitalized with diabetes who were using this treatment.
When the pandemic hit he put those research projects on hold. As a general internist, Fralick was on the frontlines in March and April treating COVID-19 patients, and he began to see opportunities where research could help find solutions.
“I realized that at this point, the most important use of my time will be dedicated towards COVID. Whether it’s caring for people with COVID, or implementing and developing research projects to help people who have COVID-19,” he says.
One of these projects is COVID-PRONE, which he is co-leading with Drs. Amol Verma and Fahad Razak at Unity Health. COVID-PRONE, a multicentre international randomized control trial, looks at whether patients with COVID-19 do better while in a prone position (lying on their stomach). In hospitals, it is typical for patients to remain on their backs for long periods of time, but this position may not be the most advantageous for those battling COVID. “It’s based on some very preliminary data, which suggests that having people lie prone, improves their oxygenation, and might reduce the risk of needing to go on to a ventilator,” says Fralick. Currently in 10 hospitals in Ontario and two in the U.S., Fralick is excited to see if the COVID-PRONE study will lead to improvements in recovery for patients.
Fralick is also the site lead for the CATCO study, which is a World Health Organization randomized trial. The study is researching the use of anticoagulants for people with COVID-19. In addition, he is part of teams doing a convalescent plasma randomized trial and a co-lead on the COVID-ACE project, which is studying those hospitalized with the virus. “The only way we will get effective treatment to people who are hospitalized with COVID is including them in trials. And if we don’t have trials, we can’t get them the treatments that they would need. So that was the impetus to shift towards randomized trial research,” he explains.
However, prior to COVID, Fralick had never run a randomized trial. “I had no plan to do randomized trials for at least the next five years. So I had to change gears very quickly,” he says. To assist him with this he reached out to BBDC researcher Dr. Bruce Perkins, who has extensive experience running clinical trials. “Bruce provided a lot of guidance and mentorship, as did other members on our trial steering committee, because this is something that I clearly was not trained to do. But with a lot of support we’ve been able to get some clinical trials on the go at Mount Sinai,” says Fralick.
This ability to adapt quickly and take on new projects as needed is part of what drew Fralick to general internal medicine and a research career. “I’ve never felt like I had one specific niche because all I care about is doing research that might potentially help the next patient who is hospitalized under a general internal medicine service,” he says. “This was unplanned, but a natural opportunity to pivot a bit.”
He also enjoys working on projects with very capable team members. Fralick is quick to point out that none of his current COVID work is solely his own. All of the projects are team-based programs with many co-investigators and collaborators.
Fralick has also dedicated a number of episodes of his podcast, The Rounds Table, to COVID-related research. The Rounds Table, which he hosts with his brother John, a general internist in Calgary, is an overview of recent research papers and findings. A helpful tool for busy health care providers, Fralick is happy to have another outlet for sharing the fast-moving information being released about the pandemic. “I think it’s become a nice platform for us to keep people up to date on COVID-19.”