Author Interviews, COVID -19 Coronavirus, Race/Ethnic Diversity, Rheumatology, UCSF / 07.11.2020
Racial and Ethnic Variability in COVID-19 Outcomes Among Patients with Rheumatic Diseases
MedicalResearch.com Interview with:
[caption id="attachment_55874" align="alignleft" width="151"] Dr. Gianfrancesco[/caption]
Milena Gianfrancesco, PhD, MPH
Assistant Professor. Education
Division of Rheumatology, Department of Medicine
University of California, San Francisco
MedicalResearch.com: What is the background for this study?
Response: This study utilized data from the COVID-19 Global Rheumatology Alliance Provider Survey, which launched on March 25th. To date, it has collected information on over 6,000 patients with rheumatic disease diagnosed with COVID-19 from over 40 countries worldwide. As COVID-19 spread across the world in the spring, and especially within the United States, it became clear that the disease was impacting certain groups more than others. Growing attention and research began to illustrate the disproportionate burden of COVID-19 among racial/ethnic minorities in the United States. We know that racial and ethnic minorities experience a higher burden of rheumatic disease risk and severity; therefore, our group was interested in examining whether the disproportionate burden of COVID-19 also affected this susceptible population.
Dr. Gianfrancesco[/caption]
Milena Gianfrancesco, PhD, MPH
Assistant Professor. Education
Division of Rheumatology, Department of Medicine
University of California, San Francisco
MedicalResearch.com: What is the background for this study?
Response: This study utilized data from the COVID-19 Global Rheumatology Alliance Provider Survey, which launched on March 25th. To date, it has collected information on over 6,000 patients with rheumatic disease diagnosed with COVID-19 from over 40 countries worldwide. As COVID-19 spread across the world in the spring, and especially within the United States, it became clear that the disease was impacting certain groups more than others. Growing attention and research began to illustrate the disproportionate burden of COVID-19 among racial/ethnic minorities in the United States. We know that racial and ethnic minorities experience a higher burden of rheumatic disease risk and severity; therefore, our group was interested in examining whether the disproportionate burden of COVID-19 also affected this susceptible population.
Dr. Spann[/caption]
Marisa N. Spann, PhD, MPH
Columbia University Irving Medical Center
New York, New York
MedicalResearch.com: What is the background for this study?
Response: Prior research has demonstrated that higher maternal pre-pregnancy body mass index is associated with adverse long-term outcomes for offspring including obesity, poorer cognitive and social abilities, and increased risk of psychiatric disorders.
MedicalResearch.com: What are the main findings?
Response: In this study, we investigated the association of maternal pre-pregnancy body mass index with fetal growth and neonatal functional connectivity and found that maternal pre-pregnancy BMI has a significant positive correlation with fetal weight and with greater thalamic connectivity of the brain. 
Dr. Sachdev[/caption]
Darpun D. Sachdev, M.D.
Case investigation and Contact tracing Branch Chief
SFDPH Covid Command Center
San Francisco Department of Public Health
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The ultimate goal of contact tracing is to rapidly identify and isolate contacts who are COVID-19 positive before they have time to transmit to others. As mentioned in the published research letter by SFDPH, through JAMA, during early shelter-in-place (from April to June 2020), our contact tracing program successfully reached greater than 80% of cases and contacts within a median timeframe of 6 days from the onset of their case’s symptoms. Approximately 10% of named contacts were newly diagnosed with COVID-19 (compared to 2% positivity during this time period). Household contacts made up approximately 80% of all identified contacts, but 90% of contacts who tested positive lived in the same household as the case. Secondary cases (contacts who were found to be newly diagnosed with COVID-19) were traced and quarantined within 6 days of the case’s symptom onset.
With that said, the 6-day time difference between symptom onset and contact notification raises concern regarding the overall effectiveness of tracing in preventing onward transmission by infected contacts. We are working with community-based organizations to scale up access to testing and culturally competent tracing and wraparound services. Currently, we have now decreased the time difference to 5 days. Moreover, given that the majority of contacts resided in the same household, transmission could have occurred presymptomatically such that by the time infected contacts were identified, they might have already transmitted the virus. Hence, why SFDPH, on May 5, 2020, implemented the recommendation of universal testing for COVID-19 contacts, regardless of symptoms.
We recommend that testing should be offered to all contacts regardless of symptoms and encourage local health departments to adopt novel ways of increasing testing access for contacts.
Dr. Adnan[/caption]
Darbaz Adnan, MBChB
Lab Research Assistant
Department of Internal Medicine - Section of Gastroenterology
Rush University Medical Center
Chicago, Illinois 60612
MedicalResearch.com: What is the background for this study?
Response: - We have conducted a large study of over 1000 patients at a major COVID-19 response center in Chicago at Rush University Medical Center, to assess for the frequency of initial GI symptoms (diarrhea, vomiting, abdominal pain) and evaluate whether these symptoms in adult COVID-19 positive could predict the disease course. Overall, 22.4% of our patients reported at least one GI symptom at the onset of their infection, with nausea/vomiting being the most common complaint. GI symptoms in COVID-19 patients were associated with worse outcomes.
Dr. Curtis J. Donskey[/caption]
Curtis J. Donskey, MD
Professor of Medicine
Case Western Reserve University
Staff Physician, Infectious Diseases Section,
Louis Stokes Cleveland VA Medical Center
MedicalResearch.com: What is the background for this study?
Response: The goal of the study was to obtain a better understanding of how healthcare-associated pathogens are transmitted. Infection control efforts tend to emphasize hand hygiene and cleaning of high-touch surfaces in patient rooms. However, there is evidence that portable equipment and floors could be underappreciated sources of transmission.
We previously found that a nonpathogenic virus inoculated onto floors in patient rooms spread rapidly to the hands of patients and to surfaces in the room and throughout the ward. This raised concern that pathogens could spread by the same route.
![MedicalResearch.com Interview with: Selin Tokez, PhD Student Department of Dermatology Erasmus MC, Rotterdam MedicalResearch.com: What is the background for this study? Response: Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer worldwide with still increasing incidence rates. Given these high incidence rates together with the associated health costs and possibility of fatal progression, it is extremely important to have accurate and complete data on the epidemiology of this disease. Nevertheless, national cancer registries in many countries do not routinely record cSCC cases and therefore currently known numbers are mainly based on incomplete data sources. Additionally, if cSCC cases are registered, this usually only concerns the first cSCC per patient while we know that, contrary to many other malignant neoplasms, patients may develop numerous cSCCs over time. MedicalResearch.com: What are the main findings? Response: In the present study, we analyzed Dutch nationwide data comprising about 145,000 patients with a first invasive cSCC diagnosis between the years 1989 and 2017. We found that the incidence rates of a first cSCC per patient almost tripled in male patients and increased about fivefold in female patients in this 30-year time period. Also, we had data on all cSCCs per patient for the year 2017 and could therefore compare this with the data on only the first cSCC per patient: incidence rates increased by 58% for men and 35% for women when multiple cSCCs were considered. In absolute numbers, this resulted in an increase of 45% in cSCC diagnoses in 2017. Lastly, we extended our analyses by predicting future cSCC incidence rates up to 2027. Given that no substantially effective measures are undertaken in the near future, current cSCC incidence rates will increase with 23% in males and 29% in females in the next decade. MedicalResearch.com: What should readers take away from your report? Response: We could summarize our main message in two points: while people generally know that cSCC is a very common disease with increasing incidence rates, it is not taken into account that these numbers are often based on incomplete data registries and that the real numbers are even higher. In this paper, we provided these numbers for a period of 30 years based on highly accurate data from the Netherlands Cancer Registry. On top of that, as a second main finding, we showed that the real burden caused by cSCC is approximately 50% higher (taken males and females together) when all cSCC diagnoses in 1 year are registered instead of only the first tumor per patient. Together with our prediction analyses that showed an on average 26% further increase for the coming decade, this will have enormous implications for the dermato-oncological health care planning and cost management. Our results urgently call for revision of skin cancer health policies to be able to cope with this rising burden of cSCC management. Ultimately, primary prevention will remain the key strategy to halt the increasing trend in cSCC incidence and the occurrence of multiple cSCCs per patient, which we hope to further stimulate with our paper as well. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: As we had data on multiple cSCCs for only one year, we would suggest to perform trend analyses for multiple cSCCs per patient as well when a longer follow-up duration has been reached. Furthermore, it would be very relevant to identify high-risk cSCCs or patients at risk for multiple cSCCs in order to be able to establish efficient follow-up regimens and take these high risk groups into account when revising skin cancer health policies. MedicalResearch.com: Is there anything else you would like to add? Response: The authors of this study have no conflicts of interest that are relevant to this article. Citation: Tokez S, Hollestein L, Louwman M, Nijsten T, Wakkee M. Incidence of Multiple vs First Cutaneous Squamous Cell Carcinoma on a Nationwide Scale and Estimation of Future Incidences of Cutaneous Squamous Cell Carcinoma. JAMA Dermatol. Published online October 28, 2020. doi:10.1001/jamadermatol.2020.3677 [subscribe] Last Modified: [last-modified] The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.](https://medicalresearch.com/wp-content/uploads/2020/10/squamous-cell-cancer-dermnetnz-image.jpg)
Dr. Maslin[/caption]
Dr. Douglas Maslin, MPhil, MB BCHir
Dermatologist and Pharmacologist
Addenbrooke's Hospital
Cambridge, UK
MedicalResearch.com: What is the background for this study?
Response: I’d like to answer this question in three parts:
Dr. Batool-Anwar[/caption]
Salma Batool-Anwar, MBBS, MPH
Instructor, Harvard Medical School
Pulmonary and Critical Care, Sleep Medicine
Brigham and Women's Faulkner Hospital
MedicalResearch.com: What is the background for this study?
Response: A well functioning sleep-wake cycle is vital to our health and prevention of chronic diseases.
During previous disaters sleep disturbances have been reported.
When Massachusetts governor declared a state of emergency in March’20, we hypothesized that sleep duration would be adversely affected by covid-19 related lockdown and stress.
The study was approved by the institutional review board and information was collected retrospectively using the electronic medical records. 
Mr. Olin[/caption]
Steve Olin
Chief Product Officer
Rally Health, Inc., part of the Optum business of UnitedHealth Grou
MedicalResearch.com: Can you please elaborate on Rally Health’s mission?
Mr. Olin: Our founding mission 10 years ago and still to this day is to put health in the hands of the individual. As a digital health company, we live this mission through our focus in three key areas:
1) Providing digital-first access to care by giving individuals easy-to-use digital tools and support to navigate their health care and take full advantage of their health benefits;
2) Engaging people in their daily health by creating experiences that people enjoy and that inspire them to perform healthy actions, and by giving them access to resources that help them achieve their health goals;
3) Saving people time and money by providing digital tools that help them understand health care costs and guide them to lower-cost, high-quality care options.
Dr. Bayes-Genis[/caption]
Antoni Bayes-Genis, MD, PhD, FESC, FHFA
Head, Heart Institute. Hospital Universitari Germans Trias i Pujol
Full Professor, Autonomous University Barcelona
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Omega-3 fatty acids are incorporated into the phospholipids of cellular membranes, including cardiac contractile cells, and have a wide range of demonstrated physiological effects. Several potential mechanisms have been investigated, including antiarrhythmic, anti-inflammatory, and endothelial.
Omega-3 fatty acids lower heart rate and improve heart rate variability, both associated with lower sudden cardiac death risk, one of the complications that may occur after a myocardial infarction.
Increased omega-3 fatty acids also enhance arterial elasticity by increasing endothelium-derived vasodilators, which is associated with blood pressure–lowering effects.
They also have a cardioprotective effect on platelet-monocyte aggregation, and lower triglyceride levels.
Dr. Mahncke[/caption]
MedicalResearch.com: What is heart failure?
Response: Heart failure – sometimes called congestive heart failure or congestive cardiac failure – is when the heart cannot pump sufficient blood flow to maintain the body’s needs. Common symptoms include excessive tiredness, shortness of breath and swelling particularly in legs. It’s treated with a combination of lifestyle changes, drugs, and devices. An estimated 6.5 million Americans are diagnosed with heart failure, with 960,000 new cases each year, leading some to describe it as reaching epidemic proportions. In older adults, it’s the most common cause of hospital readmissions within 30 days of discharge and among the most costly areas of Medicare expenditures.
Dr. Bragg[/caption]
Marie Bragg, PhD
Assistant Professor, Department of Population Health on Health Choice
NYU College of Global Public Health
MedicalResearch.com: What is the background for this study?
Response: We know from previous research that children who see food advertisements eat significantly more calories than children who see non-food advertisements. Those studies led the World Health Organization and National Academy of Medicine to issue reports declaring that exposure to food advertising is a major driver of childhood obesity.
What we don’t know is how frequently unhealthy food and beverage brands are appearing in YouTube videos posted by Kid Influencers. Kid influences are children whose parents film videos of the child playing with toys, unwrapping presents, eating food, or engaging in other family-friendly activities. The parents then post the videos to YouTube for other children and parents to view for entertainment. 
Dr. Mazzeffi[/caption]
Michael Mazzeffi MD MPH MSc
Associate Professor of Anesthesiology
Division Chief Anesthesiology Critical Care Medicine
Medical Director Rapid Response Team
MedicalResearch.com: What is the background for this study?
Response: We have known for some time that COVID19 is characterized by hypercoagulability or excess blood clotting. In fact, the incidence of blood clots in the lungs (pulmonary emboli) is as high 20% and is two to three times more common in COVID19 than in severe influenza. Further, autopsies of patients who died from COVID19 have shown that endothelial cells (cells that line the blood vessels) are damaged and that "micro clots" form in multiple organs. Together, these findings strongly suggest that excess blood clotting and endothelial cell dysfunction are defining features of severe COVID19.
For several months, my colleagues and I have been interested in whether aspirin might improve outcomes in patients with severe COVID19. In prior observational research studies, aspirin was found to be protective in patients with severe lung injury. The general idea is that aspirin reduces platelet aggregates in the lung and this improves outcome. Unfortunately, in a prior randomized controlled study (LIPS-A) aspirin was not shown to reduce the incidence of acute respiratory distress syndrome. Nevertheless, COVID19 has unique features that make aspirin more likely to be effective. Mainly COVID19 is associated with hypercoagulability to a greater degree than in other viral illnesses.