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Christine Vigeland, MD, found her calling during residency as the H1N1 pandemic was ending in 2010. She dedicated her career to researching acute respiratory distress syndrome (ARDS) and treating ICU patients. Ten years later, the knowledge she’s gained and her continued commitment to the most critical patients are guiding her through another pandemic.

By Carleigh Gabryel

“I don’t think people really understood how sick someone can get from something like the flu, until now,” said Christine Vigeland, MD, clinical instructor in the division of pulmonary diseases and critical care medicine. “Even my family. I don’t think they’ve really understood what I do and the type of patients I take care of until the past few months. I think there’s a general realization of how sick people can get and how serious these diseases are.”

Vigeland is a pulmonologist that takes care of some of the sickest patients in a hospital – those in the intensive care unit (ICU). These days those units are filled with COVID-19 patients struggling with the ravaging effects of the SARS-CoV-2 virus, which has been widely shown to cause acute respiratory distress syndrome (ARDS) in the lungs. Vigeland spends a majority of her time researching how the body’s metabolism changes when someone has ARDS, and how targeting different metabolic pathways may promote recovery.

“At the moment, I’m mostly focused on analyzing data from experiments from earlier this year on how macrophage metabolism changes in response to different inflammatory stimuli,” said Vigeland, a member of the UNC Marsico Lung Institute. Macrophages are immune cells that can destroy invading pathogens, such as bacteria or viruses.

She’s also planning future experiments, some tied to COVID-19.

“Something that’s been sparking my interest is how certain metabolic diseases like diabetes and obesity are risk factors for more severe ARDS, and they also seem to be risk factors for COVID.”

Vigeland has been interested in researching and treating ARDS since she started residency at Johns Hopkins University School of Medicine in 2010. The H1N1 pandemic was ramping down, but she was still seeing its effects.

“I would take care of people with ARDS, and I would have to explain to their loved ones that we didn’t have a treatment to cure them,” Vigeland said. “We had to hope that their lungs would heal themselves, kind of like now with COVID-19. That really drove home to me the importance of research and the ability to create treatments. I wanted to help create something better.”

And so she began. She stayed at Johns Hopkins for a fellowship in pulmonary diseases and critical care medicine. From there she chose to continue her career at UNC, where her lab has been working to better understand lung inflammation and repair.

“As of now, we don’t have treatments that are able to reverse the underlying lung inflammation in ARDS. We can treat the underlying problem that causes it, but we can only offer supportive care. We just have to hope the body heals the inflammation on its own. We want to know how to better support that process and make it happen faster.”

Faster healing is what everyone wants right now, especially the sickest COVID-19 patients.

“We are seeing people recover, but it is a long recovery. Patients could be in the hospital for days or weeks recovering from this illness.”

There are many challenges involved when taking care of ICU patients, especially during a pandemic. They need more attention, more help, and more monitoring than other patients.

“When people are so sick, we have to keep an eye on everything – how much they’re eating, how much fluid they’re getting, their oxygen levels, their heart rate. They also end up needing help to do things like using the bathroom or rolling over in bed.”

This type of care requires more contact from staff, nurses and physicians.

“We’re wearing PPE for a large amount of our 12-hour shifts, especially nurses, who may be wearing it for their entire shifts. We’ve also adapted in order to preserve PPE. We try to do our rounds on all of the patients at once, and are limiting some of the staff at the patient’s bedside to those who truly need to be there.”

Another change to their routine is the daily afternoon phone call they make to patient family members to provide updates on their loved ones’ conditions. She knows families are frustrated. They want a cure for COVID-19 that’s guaranteed to work for their friend, sibling, parent, grandparent, child or partner who is battling the virus. She hopes for patience from these loved ones, but understands their feelings and the gravity of the situation.

“It is very stressful taking care of ICU patients. You are always preparing yourself for ‘what if.’ You are always looking for problems that could pop up and cause the patient to get sicker. And sometimes they do get sicker for reasons that aren’t immediately apparent.”

Just like many other scientists and physicians, Vigeland is working towards progress – in treating current patients, in learning more about the disease, and in finding a better way forward. While the country’s attention may be focused on research in a way it potentially has never been, Vigeland is cautiously optimistic.

“Research is really a process. It takes time to figure out what’s safe and effective. We need to absorb new information with a critical eye. We have to be constantly bringing in new data to try and find the best treatment, and then we reevaluate what we’re doing to make sure it’s the right thing.”

“It’s also important to accept that research has its limitations. We’ve come very far in certain ways and with certain diseases, but there are still things like the flu that we can’t completely get rid of, in addition to new diseases arising all the time. However, research is really the only way we can make significant progress.”

“My hope for my career is to continue what I’m doing now. I love taking care of patients, and I hope with my research to help contribute to our overall understanding of ARDS, and find new treatments for this disease.”

The division of pulmonary diseases and critical care medicine is in the UNC Department of Medicine at the UNC School of Medicine.