From 'success' to 'madness': Rheumatologists share their worldwide COVID-19 experiences
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Attendees at the Association of Women in Rheumatology 2021 Annual Conference heard global perspectives from their rheumatology colleagues in Australia, Canada, Puerto Rico, the Caribbean, Brazil and India.
From Australia, Andrew Östör, MD, MA, MBBS, FRACP, FRCP, FRCP (Edin), of Cabrini Medical Center in Melbourne, shared reasons for the country’s “success” throughout the pandemic.
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“Testing and isolation, and now vaccination, have been the key to how we’re managing our patients, and also reassuring them with data coming out from around the world that they should be vaccinated,” he said.
According to Östör, the rapid lockdowns and “excellent” contact tracing in Australia have been effective strategies for containment since the start of the pandemic, as well as collaboration among politicians and compliance among citizens regarding mask guidance.
“It has been a success story overall in Australia, and the care has continued, and I believe the patients are still doing as well as they were before COVID, albeit in this new world we’re living in,” he said.
Vancouver, British Columbia
Under the leadership of their provincial health officer, Bonnie Henry, OBC, MD, MPH, FRCPC, British Columbia has seen similar success, according to Mollie Carruthers, MD, clinical associate professor at University of British Columbia.
“We Canadians have had a sense during this time of keeping each other safe and to listen to Dr. Henry and follow her public health restrictions as they were laid out, [and that] reflected our trust in government, valuing education and science and a commitment to helping each other under her guidance,” she told attendees.
The Canadian government is also paying for physicians to see their patients via phone, so patients are only being seen in-person if medically necessary. This, according to Carruthers, has helped “keep patients and our society safe.”
Puerto Rico
Although the pandemic impacted the island of Puerto Rico similarly to how it affected much of the world, Oscar Soto-Raíces, MD, a rheumatologist in San Juan, Puerto Rico, said that overall, their community of rheumatology patients has done quite well.
“At the beginning, our job at the clinic was to give as much information as possible, to acknowledge peoples’ stress and anxiety, and help them stay compliant with their treatment,” he said.
Soto-Raíces and colleagues kept patients informed of the latest developments and facts about the virus, and the vaccines, via social media and a weekly radio show that is also available on YouTube.
“We believe the information provided and the fact that [our patients] are used to protecting themselves from infections have helped them navigate through this process probably better than other patients,” he said.
The Caribbean
Amanda King-Greenidge, MD, MBBS, FRCP, Caribbean chapter leader for AWIR and founding president of the Caribbean Association of Rheumatology, is the only rheumatologist in St. Lucia. Throughout the rest of the Caribbean, less than half of the territories have a rheumatologist.
Through a survey sent to her colleagues, King-Greenidge reported that most of the territories have seen few or no cases of COVID-19 among their rheumatology patients, despite overflowing hospitals in places like Jamaica, which experienced a remdesivir shortage.
India has donated doses of the AstraZeneca vaccine, but hesitancy remains high in the Caribbean.
“Rheumatology patients across the Caribbean have expressed fear over flare of disease or vaccine-related adverse events, especially because they’re so vulnerable,” she said. “We worry about clots due to the AstraZeneca [vaccine], then there’s mis- and disinformation and a lack of a coordinated approach from the beginning, from WHO, CDC, global regional leaders and also professionals who fueled the problem with mistrust.”
King-Greenidge added that many rheumatologists in the Caribbean reported receiving numerous questions from patients, but found that through one-on-one conversations, rheumatologists could usually convince patients to vaccinate.
Brazil
As the pandemic unfolded across China and Europe in February 2020, Brazil was hosting 2 million people at their famed Carnival, according to rheumatologist and former Sociedade de Reumatologia do Rio De Janeiro president Selma Merenlender, MD.
When COVID-19 reached Brazil, Merenlender described the situation as “madness” as the country closed for 6 months.
“No one was prepared for home offices, schools and universities were not prepared,” she said. “... Families were separated, playground areas were closed, and children were afraid they would kill their grandparents.”
People washed everything, including money, and hydroxychloroquine sold out as people took the drug prophylactically to prevent infection, she explained. But in June 2020, as the first batch of tests arrived, the country reopened, and cases fell through October. In November, however, case counts rose, and New Year’s Eve festivities, which usually draw 4 million people, were canceled and an economic crisis ensued.
According to Merenlender, the situation worsened in January 2021, as hospitals collapsed and oxygen ran out. Vaccines were ultimately made available in January to health care workers aged 60 years and older, before rolling out to the larger population. However, lack of government support of the vaccine, and the promotion of drugs like chloroquine to prevent the virus, led to what Merenlender described as a “vaccine war.”
As of today, the front page of a Brazilian paper reported 95% of people admitted to the hospital were not vaccinated, and most of them were due to the delta variant.
“We’re still trying to survive it,” she said. “If we’re doing it, it’s basically because our people have joined together struggling; we don’t have much government support.”
India
In the city of Chandigarh, Shefali Sharma, MD, associate professor in the unit of clinical immunology and rheumatology in the department of internal medicine at PGIMER, said meticulous planning went into supplying a designated COVID hospital. There, personnel were trained in virology in donning and doffing PPE, and underwent education and preparation for the pandemic.
As of today, the government supplies the vaccine and more than 70% of the city’s adult population has been inoculated.
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Wright GC, et al. AWIR global: Perspectives on the COVID-19 pandemic (Australia, Brazil, India, Italy, Canada, Caribbean, Puerto Rico). Presented at: AWIR National Conference; August 12-15, 2021; (hybrid meeting).
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