Insight from 1918 flu pandemic, military ingenuity enabled ‘adapting quickly’ to COVID-19
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Lessons learned from the 1918 influenza pandemic and the pioneering use of telehealth in the military have allowed rheumatologists “to adapt quickly” to COVID-19 conditions, according to a panel of presenters.
“Pandemics are scary but not new,” Christopher Palma, MD, ScM, an assistant professor of medicine in the allergy, immunology and rheumatology division at the University of Rochester Medical Center, told attendees at the 2020 Rheumatology Nurses Society Annual Conference.
During his presentation, Palma noted that additional insights from the 1918 influenza pandemic, coupled with modern understanding of diseases and disease pathogenesis, can protect health care workers and patients with rheumatic diseases.
Lessons from the Past
Looking back, Palma noted that literature from 1918 urged both citizens and health care workers to wear masks. In the COVID-19 era, clinicians have greater understanding and advantages to help protect them.
“We know that SARS-CoV-2 turns straight to protein as soon as it enters a cell,” he said. “There is little genetic diversity, which means it can make an easy jump to humans.”
This makes infection prevention measures like masks, eye wear and hand washing all the more important, according to Palma.
Zeroing in on risk factors for COVID-19, Palma said the risks for health care workers are the same as those for the general population. They include increased age, hypertension, prior cardiovascular disease, diabetes and kidney disease.
Perhaps more importantly for the RNS audience, Palma stressed that a diagnosis of a rheumatic disease does not increase risk for acquiring COVID-19 or experiencing a more severe infection if it is acquired.
Treatments are a different story. “There is no increased risk for patients taking conventional DMARDs,” he said. “There does not seem to be an increased risk for patients taking biologics. However, more than 10 mg per day of prednisone is uniquely risky for COVID-19.”
In closing, Palma attempted to assuage fears for health care workers, noting that masks, eye protection, hand washing, social distancing and limited contact with others are keys to infection prevention. “It is all pretty consistent and uniform,” he said.
Wartime Innovation
Monica Richey, NP, part of the steering committee for the Rheumatology Advance Practice Providers association, focused much of her talk on telemedicine and technology. She said the real lessons of how to apply telemedicine, in particular, were learned from the military.
“War zones were the training ground for us,” she said. “Come COVID, there was no other way. Whether you like it or hate it, we had to adapt, and we had to adapt quickly.”
Richey acknowledged that rheumatology lagged behind many other specialties in the use of telemedicine but said the technology for telehealth has become “absolutely astonishing.”
Wearable devices can read not only pulse and body temperature, but also the amount of salt in a patient’s sweat. Three-dimensional cameras can look in a patient’s ears, lung capacity can be checked and handheld ultrasound machines are available.
The potential impact of all of this information in rheumatology is clear. “It is projected that by 2040, 78 million patients will be affected by arthritis,” Richey said. “We will never run out of patients.”
The details of how telemedicine will be used in rheumatology moving forward still need to be worked out. Verbal consent is necessary, as is the location of both the clinician and the patient. “You have to log the time spent,” Richey said. “You also have to be careful to stay within the state of your licensure.”
Meaning: if the patient resides in a place where the clinician is not licensed, the televisit should not take place or the clinician can lose their license. Overall, Richey acknowledged that there are good and bad components to telemedicine, but she believes that it is the future of rheumatology. “For me, it has been a great blessing,” she said.
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Richey M, Palma C. COVID-19: What We’ve Learned (panel). Presented at: Rheumatology Nurses Society annual conference; August 5-8, 2020 (virtual meeting).
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