Category: covid-19

ACR Update on Tocilizumab/Actemra Shortages

Posted on by Grayson

The following is a press release issued by the ACR as of yesterday, August 17, 2021:

The American College of Rheumatology (ACR) is actively engaged with the FDA Center for Drug Evaluation and Research (CDER) drug shortage team as they work with the manufacturer to resolve current shortages of tocilizumab (Actemra). Demand for tocilizumab has outpaced supply, with demand increasing after the FDA’s June 24 Emergency Use Authorization (EUA) for tocilizumab to be used for the treatment of COVID-19 in some hospitalized adult and pediatric patients.

The manufacturer has indicated in an Aug. 16 update that providers may currently find tocilizumab IV supplies to be unavailable due to high demand, but they expect IV stock replenishments by the end of August. Measures are being taken to expedite replenishments and increase manufacturing capacity and supply wherever possible, but they have indicated additional intermittent shortage periods may occur in the months ahead if the COVID-19 pandemic continues at the current pace.

According to their statement, subcutaneous formulations (pens and pre-filled syringes) continue to be available for patients prescribed tocilizumab for FDA-approved indications, and these are not authorized for treatment of COVID-19 patients under the EUA.

Providers experiencing trouble obtaining tocilizumab IV or any other issues related to COVID-19 can contact the ACR at COVID@rheumatology.org.

Rheumatology Patients on Immunosuppressive Medications Qualify for Third COVID-19 Vaccine Dose

Posted on by Grayson

The following is a press release from the ACR released within half an hour of this post:

The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices today recommended that rheumatology patients being actively treated with high-dose corticosteroids, alkylating agents, antimetabolites, tumor-necrosis factor (TNF) blockers, and other biologic agents that are immunosuppressive or immunomodulatory receive a third dose of the Pfizer-BioNTech or Moderna mRNA COVID-19 vaccines.

The approval came one day after the FDA announced it would be revising the current emergency use authorizations (EUA) for the two mRNA vaccines to permit a third dosage in certain immunocompromised patients. The recommendation applies for ages 12 and older for individuals receiving the Pfizer-BioNTech vaccine and18 and older for patients receiving the Moderna vaccine. The new EUA is specifically for the two mRNA vaccines and does not extend to recipients of the Johnson & Johnson vaccine currently.

“This will be enormously important for our immunocompromised patients, and we are thankful to the FDA and CDC for hearing our concerns, recognizing the needs of this population and moving forward,” stated ACR President Dr. David Karp. “We look forward to working with the agencies as they communicate this new recommendation.”

The additional dose of mRNA COVID-19 vaccine should be administered at least 28 days after completion of the primary vaccine series, and patients and providers should stick to the same brand for the third dose, if possible. No determination was made on the safety of receiving one of the mRNA vaccines if a patient initially received the Johnson & Johnson shot.

All immunocompromised patients, including those who receive an additional mRNA dose should continue to follow prevention measures, including:

  • Wearing a mask
  • Staying 6 feet apart from those they don’t live with
  • Avoiding crowds and poorly ventilated indoor spaces until advised otherwise by their healthcare provider
  • Close contacts of immunocompromised people should be strongly encouraged to be vaccinated against COVID-19.

These preventative measures remain critical due to real-world data that shows immunocompromised individuals are more likely to have a lower response to the initial vaccine dosage and are more likely to experience breakthrough infections. According to the CDC, 40-44 percent of hospitalized breakthrough cases are immunocompromised patients.

In a recent randomized trial of a third dose of Moderna vaccine in transplant recipients, 33 – 50 percent of those who had no detectable antibody response to an initial mRNA vaccine series developed one with a third dose, and the proportion of the group who are seropositive increased to 68 percent with the third dose. No serious adverse events were reported, and the symptoms reported were consistent with previous doses, with mostly mild or moderate symptoms reported.

The CDC noted that the effectiveness and accuracy of antibody testing are still being evaluated. Patients who are moderately to severely immunocompromised should discuss a third dose with their providers.

“Not all medications that our patients take have been shown to have significant effects on responses to vaccination. Patients should ask their provider if they are likely to see a beneficial effect from additional vaccination,” Dr. Karp said. “Luckily, we have not seen any safety signals in patients with autoimmune and rheumatic diseases from the COVID-19 vaccines, so there should be no concern for the third dose.”

The ACR’s COVID-19 Vaccine Clinical Guidance Task force is meeting Monday, Aug. 16 to discuss potential changes to the ACR’s clinical guidance and expect to share recommendations shortly after.

For more on this, you can also check out the recent town hall webinar from ACR now uploaded to YouTube.

Wednesday Town Hall on Effectiveness of COVID-19 Vaccination in Immunosuppressed Patients

Posted on by Grayson

How effective COVID-19 vaccines have been in immunosuppressed and rheumatic disease patients remains an incompletely answered question. The American College of Rheumatology (ACR) has organized an expert panel to share details on what we are learning from real-world data collection efforts and answer questions from the audience.

Speakers include:

  • Michael R. Anderson, MD, MBA, FAAP, FCCM, FAARC, Senior Advisor at the HHS Office of the Assistant Secretary for Preparedness and Response in Washington, D.C., and a key leader on the federal COVID-19 monoclonal antibody therapeutics team
  • Marcus Snow MD, Rheumatologist at Nebraska Medicine; Assistant Professor of Internal Medicine, University of Nebraska Medical Center; and Chair of ACR Committee on Rheumatologic Care
  • Kwas Huston MD, Rheumatologist at Kansas City Physician Partners and Clinical Associate Professor of Medicine, University of Missouri Kansas City
  • Alfred Kim MD, PhD, Assistant Professor, Division of Rheumatology, School of Medicine at Washington University in St. Louis
  • Jean Liew, MD, MS, Assistant Professor, Rheumatology, Boston University School of Medicine

The webinar is scheduled for 7 pm Eastern/4 pm Pacific on Wednesday, August 4. Register Online for free access and to submit questions.

Update: if you missed this webinar, the recording is below:

ACR COVID-19 Vaccine Guidance Recommends Vaccination, Addresses Immunosuppressant Drugs & Patient Concerns

Posted on by Grayson

The following is a press release from ACR dated February 11.

The American College of Rheumatology (ACR) has released its COVID-19 Vaccine Clinical Guidance Summary that provides an official recommendation to vaccinate rheumatology patients with musculoskeletal, inflammatory and autoimmune diseases.

“Although there is limited data from large population-based studies, it appears that patients with autoimmune and inflammatory conditions are at a higher risk for developing hospitalized COVID-19 compared to the general population and have worse outcomes associated with infection,” said Dr. Jeffrey Curtis, chair of the ACR COVID-19 Vaccine Clinical Guidance Task Force. “Based on this concern, the benefit of COVID-19 vaccination outweighs any small, possible risks for new autoimmune reactions or disease flare after vaccination.”

The guidance was developed by a multi-disciplinary panel of nine rheumatologists, two infectious disease specialists, and two public health experts and is intended to give direction to providers treating rheumatology patients on how to best use COVID-19 vaccines, as well as facilitate implementation of vaccination strategies for rheumatology patients.

“Our members have been inundated with questions and concerns from their patients on whether they should receive the vaccine,” said Dr. David Karp, President of the ACR. “We hope the guidance will provide them evidence-based reassurance that their patients will benefit from being vaccinated and guidance on how to best incorporate it into their treatment plans to maximize vaccine efficacy.”

Important considerations and caveats on how to approach vaccination are included for patients with high disease activity and/or those taking immunosuppressant treatments. These include recommendations to modify certain treatments such as methotrexate, JAK inhibitors (e.g., baricitinib, tofacitinib, upadacitinib) and some biologics (e.g., abatacept and rituximab) that alter the immune system’s response in ways that might affect vaccine response.

The panel based their recommendations on the use and timing of immunomodulatory medications on evidence extrapolated from their immunologic effects as they relate to other vaccines and vaccine types. As such, these and other recommendations made by the task force should be considered ‘conditional.’

“There was vigorous debate on several topics such as the expected magnitude of benefit of vaccination for patients receiving therapies that substantially alter or suppress the immune system (e.g., high dose steroids),” said Curtis. “Ultimately, the task force agreed that in almost all cases, proceeding with vaccination and obtaining at least a partial response would be better than deferring vaccination, since deferring provides no protection at all. Given the lack of direct evidence for these vaccines in rheumatology patients, the panel applied general immunologic principles observed with other vaccines to make recommendations on how to increase the likelihood of a favorable vaccine response.”

“For example, an RA patient with well-controlled disease may benefit from holding a dose of methotrexate immediately following vaccination,” added Karp. “In the case of drugs with long dosing intervals such as rituximab, there are some circumstances where it may be beneficial to time the vaccine around when the last dose was given to maximize the vaccine’s efficacy. We encourage clinicians to study the charts we’ve provided in the summary for details on how they can time various medications to ensure maximum success.”

Given the uncertainty surrounding when alternative vaccine types will become available, the task force focused on the two mRNA COVID-19 vaccines available in the U.S. at the time of their deliberation. No preference for one vaccine over another was stated, and patients are recommended to receive whichever of the mRNA vaccines is available to them.

“With efficacy about the same for both vaccines, we felt it was not important which brand patients received. Realistically, many individuals will not have a choice, as availability varies by site and region. Therefore, it was important to assure providers and patients this was not a factor to consider when discussing vaccination. However, patients should stick to the same vaccine brand for both injections,” stated Curtis.

The ACR has voiced that recommendations in the guidance should not replace clinical judgement, and decisions about individual patients should be made as part of shared decision-making with patients that considers their underlying health condition(s), disease activity level, current treatments, risk of exposure to SARS-CoV-2 and geography. Patients are also encouraged to continue following all public health guidelines regarding mask wearing, physical distancing and other preventive measures even after vaccination.

Future changes are expected to the guidance as more safety and efficacy data about the existing two mRNA vaccines, other vaccine platforms, and vaccine response specific to rheumatic disease patients become available.

“This is very much a ‘living document,’ and the task force already has plans to evaluate additional data in the coming weeks,” said Curtis. “We desperately need direct evidence from high quality research. To reach that goal, we would issue a call to action for patients, providers and researchers to mobilize and support the important research efforts that are underway to study vaccine effectiveness and safety in rheumatology patients.”

The ACR is hosting a town hall with members of the task force on Tuesday, Feb. 16, at 7:30 p.m. EST to discuss the guidance and answer questions about the recommendations. Members of the press are invited to attend and encouraged to register online. Questions about the guidance can be submitted when registering.

A peer-reviewed manuscript with additional details on the clinical studies, data, and discussion points that influenced the recommendations has been submitted for publication to Arthritis & Rheumatology. It will be made available on the ACR website once published.

Rheumatology Leaders and Patient Advocates Urge Congress to Address Care Challenges Exacerbated by COVID-19 During the Virtual “Advocates for Arthritis” Event

Posted on by Grayson

The following is a press release issued by ACR today:

The American College of Rheumatology (ACR) will hold its first virtual Advocates for Arthritis event on Tuesday, Sept. 15, where more than 120 rheumatologists, rheumatology health professionals, and patient advocates will meet with lawmakers via video to discuss the healthcare challenges they are facing in the midst of COVID-19. During the event, advocates will urge lawmakers to adopt legislation that ensures continued delivery of accessible, safe and affordable care throughout this public health emergency and beyond.

“The pandemic has altered almost every aspect of our rheumatology practices,” said ACR President Ellen Gravallese, MD.  “It has impacted our patients’ lives significantly and required us to create new ways of delivering care through improved telehealth and other adaptations.”

Rheumatology providers face significant resource challenges as a result of the current climate. As providers work to balance patient safety and continued access to care, many have been forced to retool their operations, move a significant portion of visits to telehealth, source their own personal protective equipment (PPE), and help patients navigate drug supply challenges – while in many cases operating with less staff due to social distancing protocols, furloughs and layoffs.

Meanwhile, patients are concerned about their ability to access rheumatic care while avoiding exposure to the SARS-CoV-2 virus. A recent national patient survey conducted by the ACR found a 52 percent decline since 2019 among patients who say they are currently being treated by a rheumatology provider. Further, 66 percent of respondents reported using telehealth for rheumatology visits, with  COVID-19 cited as the most common reason. While telehealth has been a welcome option for providers and patients alike, some visits – such as those involving biologic therapy infusions – must be conducted in-person via an office visit.  Additionally, the rheumatology workforce shortage has made it increasingly difficult for patients in rural areas to find a practicing rheumatologist.

According to the latest federal estimates, 54 million Americans have a doctor-diagnosed rheumatic disease. A recent academic study suggests that number that could be as high as 91 million when taking into account symptoms reported by undiagnosed individuals. Even though as many as one-quarter to one-third of U.S. adults may be living with a rheumatic disease, there is an average of only one practicing rheumatologist for every 40,000 people, while it is estimated that the U.S. will need thousands more adult rheumatologists by 2030 to meet the challenges caused by a rapidly aging population and a fast-retiring workforce.

To address these challenges and ensure the continued delivery of high-quality care, rheumatology providers and patients are encouraging Congressional leaders to adopt the following legislative solutions:

  • Health Care at Home Act (H.R. 6644/S. 3741) – This legislation would require all employer-sponsored ERISA-regulated health insurance plans to provide reimbursement for telehealth visits (including audio-only visits) at the same rate as in-office visits for the duration of the COVID-19 Public Health Emergency.
  • The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act (H.R. 4932/S. 2741) – This legislation would expand telehealth services through Medicare and make it easier for patients to connect with their providers.
  • The Resident Physician Shortage Reduction Act (H.R. 1763/S. 348) would better prepare the nation for its next health care crisis by increasing the number of residency positions eligible for Medicare support by 15,000 slots over five years. Further, the legislation requires that at least 50% of the additional 3,000 slots added each fiscal year be directed to a “shortage specialty” residency program as identified by the Health Resources and Services Administration (HRSA), like rheumatology.
  • Funding for the Pediatric Subspecialty Loan Repayment Program (PSLRP). This program supports loan repayment and pediatric provider training experiences for primary care and dentistry providers who serve rural and underserved areas or community-based settings.  Reauthorization of this program was included in the CARES Act but has not been funded.
  • The Healthcare Workforce Resilience Act (H.R. 6788/S. 3599) reallocates to healthcare workers visas that were previously authorized by Congress and have not been used. Of these, 15,000 visas would be reallocated for international medical graduates and 25,000 visas for international nurses to ensure durable immigration status for our vital workforce.

Noting the precarious financial state of cognitive care specialists who treat complex conditions, rheumatology leaders are also urging lawmakers to support the Centers for Medicare & Medicaid Services’ important updates to the Physician Fee Schedule slated to take effect in January 2021. Established in concert with the American Medical Association, these updated reimbursements for complex office visits – also known as “Evaluation and Management” (E/M) visits – are critical to ensuring specialties on the front lines of treating chronic illness can continue serving patients in need.

“While the rheumatology community has adapted to meet these challenges head-on, there is serious concern about the long-term sustainability of this new practice landscape without additional, targeted federal interventions and funding support from lawmakers,” said Gravallese.

Racism is a Public Health Crisis

Posted on by Grayson

More white people are waking up to how insidious racism is. It’s both great and upsetting at the same time. It should not have taken this long for people to see the issue and want to address it.

In public health, we often talk about the notion of racism and discrimination being a part of society’s culture. Some types of discrimination are especially clear in different types of settings. For example, ageism plays a huge role in pain management. Young people aren’t believed about pain. Older folks are presumed to have little quality of life, and are either over or undertreated.

While racism is not just an issue that affects only Black folx, I am focusing this piece mostly on Black pain due to racism.

When we say ‘racism is a public health crisis,’ what does that mean?

The following is from a Rolling Stone article entitled ‘Racism Kills: Why Many Are Declaring It a Public Health Crisis‘ –

When it comes to discussing racism and public health, words matter. Specifically, [Mary] Gregory says that it’s important to refer to racism as a public health “crisis” instead of an “issue.” Not only is it more accurate, she says that racism also meets the four criteria the CDC requires in order for something to be considered a public health problem. That means that (1) it places a large burden on society that continues to increase, and (2) impacts certain parts of the population more than others. In addition to that, (3) there’s evidence that preventative strategies could help, but (4) this hasn’t happened yet. And while we’re on the subject of words, Gregory wants to remind us that when we talk about “race,” we’re really talking about skin color. “There is one race on this planet — homo sapiens — and to use the word ‘race’ in talking about skin color is our first mistake,” she explains.

I highly suggest reading that article. It’s a fantastic picture of racism as a crisis.

Here in Wisconsin, it might be even worse than in some states. Still, despite Milwaukee being one of the most segregated cities in the US, Wisconsin was the first state to declare racism a public health issue.

Let’s examine just some of the ways that racism can impact someone’s life.

 

Environmental Racism

The Flint water crisis is still happening. They still do not have clean water, and it’s been SIX YEARS. The government continues to fail to address this issue in a way they wouldn’t be able to if Flint was full of white middle-class people. The only way they’re getting away with this is because the population is primarily BIPOC (Black, Indigenous, & People of Color) folx living in poverty.

 

Medical Racism

Black folx are around four times more likely to die of pregnancy complications than white folx.

Black people, on average, have a lower life expectancy than whites. In addition to outright physical violence, part of why this occurs is the chronic stress of being Black. As we well know, stress can cause and worsen chronic conditions. Combine this with a lack of access to medical care – or not trusting the medical system because it routinely engages in racism – and it’s a recipe for disaster.

Currently? We know that BIPOC are one of the groups dealing with the most impact from Covid.

 

Police

I recently covered the 2015 murder-by-cop of Madison-local Tony Robinson for my podcasts. You can listen here.

Police continue to murder Black folx at higher rates. The police ‘issue’ isn’t something we ignore, either, as half of all people murdered by cops are disabled.

A lot of people think that means the policing system needs reform. In reality, white people created policing exactly this way. The notion of police in America came out of that of the slave catchers. That’s right – the police developed from a system literally only designed to protect the property, livelihood, and well-being of white people. It likely goes without saying that, as time went on, this also meant the police attacked and oppressed anyone they saw as a threat to that – disabled, trans, queer, BIPOC, etc.

 

Institutional Racism

Each of these types of racism is a part of institutional racism. It’s much worse than most white folx realize.

Moving into the Civil Rights era, white people took special care to ramp up attacks on Black folx. Lawmakers drafted and passed laws around public housing, financial assistance, and many other areas. They did this to specifically target Black communities. These included laws against those convicted of felonies and drug charges living in public housing or lowering their job prospects. This combined with police increasing patrols and arrests in Black communities began to lead to the higher incarceration rates for Black folx – particularly Black men. That later transferred to affect all genders while simultaneously forcing those who are transgender or gender non-conforming into incorrectly gendered facilities where they face additional harm from guards and fellow inmates.

Combine all of that with the increase in social workers stealing children to put them in foster care under false pretenses, the school-to-prison pipeline, and rapid underfunding of any organization that might actually be able to help? It’s a recipe for disaster.

Black people are then gaslit and told that these systemic forms of oppression are their fault. While nothing could be further from the truth, the impact of those lies cannot be understated.

 

Epigenetics

Now, imagine this going on for any of our families for half a millennium. Consider what it would mean if we couldn’t even trace our ancestry back that far because no one had cared to collect our family stories. There’s a lot of trauma that can affect people in many ways.

Epigenetics is the study of how our DNA changes how it expresses itself in response to things like diet, exercise, and stress. Toxic stress can cause long-term problems including post-traumatic stress, changes in brain physiology, and more. These changes pass down through generations. The stress of going through abuse can be passed down to the abused person’s children, etc. This applies to historical trauma, such as slavery, too.

Epigenetics is such a new field of study that we have no knowledge yet around how to help heal those wounds. There is a specific type of post-traumatic stress called Post-Traumatic Slave Syndrome. Things like therapy can be helpful for our own experiences, but can they touch on historic pain? Not really.

 

What do we do now?

If you’re white – and, from my readership stats, I know you probably are – it’s time to start learning. Here are a few resources:

ACR Offers New Recommendations Following COVID-19 Infection in Adults with Rheumatic Disease

Posted on by Grayson

The American College of Rheumatology has added two new recommendations to its COVID-19 Clinical Guidance for Adult Patients with Rheumatic Diseases. The new updates focus on treatment following a COVID-19 infection and include:

Reinitiating Treatment Following COVID-19

  • For patients with uncomplicated COVID-19 infections (characterized by mild or no pneumonia and treated in the ambulatory setting or via self-quarantine), consideration may be given to re-starting rheumatic disease treatments (e.g., DMARDs, immunosuppressants, biologics and JAK inhibitors) within seven to 14 days of symptom resolution. For patients who have a positive PCR test for SARS-CoV-2, but are (and remain) asymptomatic, consideration may be given to re-starting rheumatic disease treatments (e.g., DMARDs, immunosuppressants, biologics and JAK inhibitors) 10 to 17 days after the PCR test is reported as positive (H).
  • Decisions regarding the timing of reinitiating rheumatic disease therapies in patients recovering from more severe COVID-19-related illness should be made on a case-by-case basis (H).

The (H) at the end of both of these statements stands for “high” and is related to the consensus during voting by the task force on these two new recommendations.

You can read the full PDF here.

ACR Releases Two New COVID-19 Clinical Guidance for Pediatric Patients

Posted on by Grayson

ACR has created two new task forces to address pediatric concerns during the SARS-CoV-2 (COVID-19) pandemic. The first is the COVID-19 Pediatric Rheumatology Clinical Guidance Task Force and the other is the Multi-System Inflammatory Syndrome in Children (MIS-C) and COVID-19 Related Hyperinflammation Task Force.

On June 18th, both task forces have released new clinical guidance and recommendations for the care of pediatric patients in the context of COVID-19. All recommendations are based on current knowledge and will be updated as new scientific evidence accumulates.

For the COVID-19 Clinical Guidance for Pediatric Patients with Rheumatic Disease, recommendations include, but are not limited to, the following:

  • Routine ophthalmologic surveillance of patients at high risk for chronic uveitis or with a history of uveitis should continue on schedule via in-person visits with slit lamp examination.

In ongoing treatment of pediatric patients who do not have COVID-19 exposure or infection:

  • NSAIDs, hydroxychloroquine (HCQ), angiotensin-converting enzyme inhibitor (ACEi)/ angiotensin II receptor blocker (ARBs), colchicine, conventional DMARD (CDMARD), biologic DMARDs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) may be continued or initiated to control underlying disease. Glucocorticoids may be continued or initiated, using the lowest dose possible to control underlying disease.
  • For pediatric patients with life and/or organ threatening manifestations, high dose oral or intravenous “pulse” glucocorticoids and cyclophosphamide may be initiated to control underlying disease.

In pediatric patients with ongoing treatment who have close/household exposure to COVID-19:

  • Initiation of high dose oral or intravenous glucocorticoids should be delayed for 1-2 weeks, if deemed safe by the treating provider, for pediatric patients with non-life and/or organ threatening manifestations. For those patients with life and/or organ threatening manifestations, the initiation of high dose oral or intravenous glucocorticoids should not be delayed.

In patients with ongoing treatment of pediatric patients with asymptomatic COVID-19 infection:

  • NSAIDs, HCQ, colchicine, cDMARDs, bDMARDs, tsDMARDs, cyclophosphamide or rituximab may be continued, if necessary, to control underlying disease.

In patients with probable or confirmed COVID-19 infection:

  • cDMARDs, bDMARDs (except IL-1 and IL-6 inhibitors), and tsDMARDs should be temporarily delayed or withheld, and IL-1 and IL-6 inhibitors may be continued, if necessary, to control underlying disease.

For the Clinical Guidance for Pediatric Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 and Hyperinflammation in COVID-19, the guidance offers direction on diagnostic evaluation of MIS-C, compares and contrasts MIS-C and Kawasaki Disease, and provides general recommendations for cardiac management, immunotherapy treatment, and anti-blood clotting therapies in MIS-C. Recommendations include, but are not limited to, the following:

  • MIS-C and Kawasaki Disease unrelated to COVID-19 infections may share overlapping clinical features, including conjunctival injection, oropharyngeal findings (red and/or cracked lips, strawberry tongue), rash, swollen and/or erythematous hands and feet, and cervical lymphadenopathy.
  • For cardiac management, EKGs should be performed at a minimum of every 48 hours in MIS-C patients who are hospitalized as well as during follow-up visits.
  • For anti-blood clotting therapy, the guidance recommends treatments of daily, low dose aspirin, of no more than 81 mg/day, be used in patients with MIS-C and Kawasaki Disease-like features and/or those with a high platelet count (≥450,000/𝜇L). This treatment should be continued until normalization of platelet count and confirmed normal coronary arteries at ≥4 weeks after diagnosis. Treatment with aspirin should be avoided in patients with a platelet count of ≤80,000/𝜇L.
  • Children with severe respiratory symptoms due to COVID-19 with any of the following should be considered for immunotherapy: acute respiratory distress syndrome, shock/cardiac dysfunction, elevated lactate dehydrogenase enzyme, D-dimer, IL-6, IL-2R, and/or ferritin, and depressed lymphocyte count, albumin, and/or platelet count. Glucocorticoids may be considered for use as immunomodulatory therapy in patients with COVID-19 and hyperinflammation (as outlined in the previous statement).

The full list of guidance statements can be found on the ACR website at https://www.rheumatology.org/announcements.

What is Public Health?

Posted on by Grayson

With the current pandemic, we’ve seen a lot about Public Health departments or professionals. From local news to national briefings, these individuals often share warnings and other information. But, what is Public Health?

Well, it’s a little complicated to explain.

Definitions of Public Health

The short version? Public health is the study of preventing disease and improving life for the general public.

One of the leaders in public health, Charles-Edward A. Winslow, described it as:

The science and the art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts for the sanitation of the environment, the control of community infections, the education of the individuals in principles of personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health. (Schneider, Mary-Jane, 2006. Introduction to Public Health. pg 5)

This is a pretty confusing definition in my opinion. But, it also encompasses much of what those in this field do. Part of why it’s difficult to nail down is that this field is huge. It includes epidemiologists (those who study determinants of health and diseases), public policy personnel, and reproductive/sexual health educators. We often see medical professionals involved, too, such as nurses, doctors, and therapists.

The world of medicine is often focused on how to diagnose and treat conditions. In contrast, public health is focused on what makes people more susceptible, countering anti-vaccination misinformation, educating the public, and tracing infections. It takes an interdisciplinary team to handle the issues we find. That’s especially true in a pandemic! This includes the distribution of tests, recommendations for how to keep us safe, and tracing who infected individuals may have had contact with.

What does this look like in action?

One great illustration of what this field looks like is the Centers for Disease Control and Prevention, AKA the CDC. The main goal of the CDC is to protect the general public. They do this with a staff full of those who study diseases and outbreaks, health promotion, preventing injuries, and tracking chronic disease statistics. The CDC also talks a lot about emergency preparedness, something integral to the public’s wellbeing.

Another great example is your state’s Department of Health Services. Public health measures often live here and maybe their own department or division under the DHS umbrella. DHS may cover the following aspects of public health:

  • Certifications for caregivers
  • Alcohol licenses
  • Healthcare coverage information (particularly Medicaid & Medicare)
  • Long-term care information
  • Mental health resources
  • Climate change
  • Specific health challenges for marginalized communities (e.g., Black and Brown folx, migrants, refugees, LGBTQ+)
  • Nutrition and food assistance
  • Vaccination rates
  • Demographic and population information
  • Chronic disease statistics, interventions, and prevention

They also work on grants from places like the CDC to see how to make positive changes in communities, especially around chronic diseases.

Local universities will also often be involved in these efforts, especially in areas with world-renowned higher education facilities. Departments there involved might include the medical school, school of nursing, epidemiology, oncology, population health, and more.

Cool, right?

I’m a nerd, so, of course, I think it’s cool. I also just started officially working in public health!

I get to help improve communications for the chronic disease prevention team. They work a lot on efforts related to stroke, heart disease, type 2 diabetes, and oral health. I’m really excited!

So, do you have questions about Public Health?