ACR president: In COVID-19 care, rheumatologists should be 'in the room where it happens'
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Reflecting on a presidential term defined by COVID-19, American College of Rheumatology President Ellen Gravallese, MD, praised rheumatologists who have “embraced adversity,” and emerged as a critical voice in the fight against the pandemic.
“What I have witnessed in the field of rheumatology in response to this pandemic has been nothing short of remarkable,” said Gravallese, a professor of medicine at Harvard Medical School and chief of rheumatology, inflammation and immunity at Brigham and Women’s Hospital, as she opened the 2020 ACR Convergence meeting. “There are so many examples. In the face of a vacuum of data on the outcomes of patients with rheumatic disease who contract COVID-19, physician-reported registries have sprung up around the globe to collect information on patients with rheumatic diseases who contract this disease.”
“Here in the United States, ACR members have addressed this crisis with resilience and collaboration, continuously finding creative solutions to new challenges,” she added. “We do this because we care, deeply. We care about our patients, about science, about our specialty and about each other.”
According to the ACR president, rheumatologists possess the qualities that are needed to persevere, and “come out of this as a stronger discipline,” because of the lessons learned throughout the COVID-19 pandemic — the first of which is that the specialty’s own knowledge and insights are highly relevant.
Describing immunology as the “cornerstone of medicine,” Gravallese said rheumatologists, as the content experts in immunology, can provide knowledge that no other specialty has.
“We have an intimate understanding of immune cell types and pathways, of cytokines, chemokines and their actions,” she said. “We understand better than any other specialty the pharmacologic and therapeutic issues surrounding cytokine blockade and the risks and benefits of immunosuppressive therapies. This knowledge has been critical in the care of patients with COVID-19, especially in the setting of severe disease. Several of our therapies have been tested in patients with COVID-19 and our input in directing the care of these patients has been critical.”
“We should embrace this strength and utilize immunology expertise not only in the direct care of patients, but also in the design and implementation of new clinical trials, and in the development and use of vaccines,” Gravallese added. “We should always be in the room where it happens.”
According to Gravallese, rheumatologists should be advising hospital teams caring for patients with all diseases that affect the immune system, using COVID-19 as an example.
“I can think of no other time in recent history when the work that we do as rheumatologists in immunology, medical research and patient care has been more critical, helping to drive an insightful and evidence-based approach,” she said.
Other lessons learned firsthand by rheumatologists in general, and the ACR leadership specifically, from the COVID-19 pandemic include a need to broaden collaborative efforts with other specialties, as well as to learn how best to use telehealth and virtual learning technologies, so that face-to-face interactions do not become a lost relic.
In addition, Gravallese said the organization itself may need to be restructured, to better react to a crisis. She said the COVID-19 pandemic has highlighted the urgent need for structural change within the ACR, noting an effort that began last year to examine the group’s organizational structure. As a result, the ACR has launched a task force aimed at rethinking its governance structure, with the guiding principle that “good nonprofit governance is all about focusing on the processes for making decisions that will advance the organization,” the president said.
“During my term as president, I have seen, in this most difficult of years, rheumatologists across the globe come together,” Gravallese said. “You have thought creatively about how to address the challenges faced by this pandemic, how to best serve the patients who depend upon us, and how to continue to move research forward in our field. Every single person who was asked to assist the ACR in our efforts to respond to this pandemic has risen to the occasion without hesitation, enthusiastically volunteering their time to address this crisis.”
“Those within the ACR, those in our practice communities, in our academic divisions and in institutions throughout the world — as rheumatologists, you have persevered with optimism and hope,” she added. “We know we can go forward from here, highlighting our expertise in immunology, collaborating with colleagues in other specialties, and reorganizing our institutions to be more nimble and responsive. We can the best of what we have learned about communication to optimize telehealth and medical education, all while holding on to the precious ability to discuss new ideas and concepts face-to-face with our colleagues, both locally and globally.”
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Gravallese E. Welcome and presidential address. Presented at: ACR Convergence 2020; November 5-9, 2020 (virtual meeting).
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