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COVID-19 Vaccine: What We Need To Know

While we are living in the third peak of COVID-19 pandemic, we have been delighted to hear about the recent food and drug administration (FDA) approval of the COVID-19 vaccine, after trials involving hundreds or more of patients showed the vaccine safety and efficacy [1,2]. However, the COVID-19 vaccine is associated with some side effects, which in fact might be more common than the flu vaccine. Healthcare workers and first responders will have the priority to get the vaccine at many institutions given their high-risk work environment. So, I decided to share some knowledge about some of the side effects of the vaccine I recently read about and how institutions are planning to stagger the vaccines among their employees.

What are the side effects of the vaccine?

Side effects seem to be more common than the annual flu vaccine, with arm pain at the injection site, generalized fatigue and malaise, headaches, dizziness, fever, chills, nausea, vomiting, and diarrhea. Rare side effects include Bell’s palsy and temporary facial muscle paralysis. Most of these side effects are mild and resolve in a few days. These side effects occur more frequently after the second dose of the vaccine. These side effects actually suggest reactogenicity and that the immune system is responding to the vaccine [1,2].

Are there long-term adverse events of the COVID-19 vaccine?

This is still unknown and under close monitoring by FDA [1].

How will the vaccine change things from now on?

The COVID-19 vaccine is an additional protection layer, but it does not substitute the other protection measures we have been following; that means we should still conform to social distancing and follow hygienic instructions wherever we go till the pandemic is over. This pandemic has taught us all, as a healthcare professional and as members of the community, to be responsible for our actions toward each other and persist despite all the obstacles. The vaccine could be the first step that leads us back to “normal life” as long as we stay responsible for each other.

REFERENCES

[1] Walsh EE, Frenck RW Jr, Falsey AR, et al. Safety and Immunogenicity of Two RNA-Based Covid-19 Vaccine Candidates [published online ahead of print, 2020 Oct 14]. N Engl J Med. 2020;NEJMoa2027906. doi:10.1056/NEJMoa2027906

[2] Yuan P, Ai P, Liu Y, Ai Z, Wang Y, Cao W, Xia X, Zheng JC. Safety, Tolerability, and Immunogenicity of COVID-19 Vaccines: A Systematic Review and Meta-Analysis. medRxiv [Preprint]. 2020 Nov 4:2020.11.03.20224998. doi: 10.1101/2020.11.03.20224998. PMID: 33173896; PMCID: PMC7654888.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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COVID-19 Vaccine & Cardiovascular Disease: What We Know So Far

It’s hard to believe the majority of 2020 was spent in a pandemic. The world came to a screeching halt and the entire scientific community worked tirelessly to find ways to keep each other safe. However, we all have experienced highs and lows due to COVID-19. But we were fortunate to have Operation Warp Speed to help produce and deliver millions of doses of safe and effective vaccines against the COID-19 virus.1

It is well known that traditional risk factors such as hyperlipidemia, hypertension, diabetes, and obesity are modifiable risk factors for coronary artery disease. Through the evolution of research, inflammation and infection were also discovered to play a role in developing an acute myocardial infarction (MI).2,3 After the epidemics of influenza in Europe and the US in the early 1900s, it was speculated that there is a relationship between influenza and MI. This was on the basis that excess mortality was due to other causes than influenza, such as heart disease.4 Mechanistically, influenza causes platelet aggregation leading to MI. This finding (along with others) led the American Heart Association and American College of Cardiology in 2006 to recommend influenza immunization as a part of comprehensive secondary prevention in persons with coronary and other atherosclerotic vascular diseases (class I, level B).5

Based on our past experiences of viral infections and the current pandemic-state, what emerged was that on November 20, 2020, Pfizer and BioNTech (the sponsor) submitted an Emergency Use Authorization (EUA) request to the FDA for an investigational COVID-19 vaccine. The purposed use under a EUA is for active immunization for the prevention of COIVD-19 caused by SARS-CoV-2 in individuals 16 years of age and older; with a 2 doses regimen, administered 21 days apart.1

There are many safety and side effects to discuss regarding the vaccine (any vaccine for that matter) but I’ll be focusing on the cardiovascular risk profile. The most frequent comorbidities were obesity (35.1%), diabetes (8.4%), and pulmonary disease (7.8%).1 Other baseline characteristics included: myocardial infarction (1%), peripheral vascular disease (0.6%), congestive heart failure (0.4%), and hypertension (24.5%).1

Of the serious adverse events, a total of 6 deaths (2 vaccines, 4 placeboes) from the total 43,448 participants occurred. Both vaccine recipients were >55, one experienced a cardiac arrest 62 days after the second vaccination dose and the other died from arteriosclerosis 3 days after the first dose. From the placebo group, only 1 patient died from an MI. Interestingly, 1 patient had ventricular arrhythmia but was known to have cardiac disease. Overall, there was no imbalance in severe adverse cardiovascular events. In general, serious adverse events were uncommon and represented medical events that occurred at a similar frequency in the general population.1

Some of the gaps from the safety reporting of the COVID-19 vaccine includes; duration of protection – as the participants are not more than 2 months out from initially receiving the vaccine, the et of immunocompromised individuals is too small to evaluate efficacy (i.e. heart transplant recipients ), children <16, and pregnant/lactating individuals.

Where does this leave us as leaders in the health community? We can recognize that the benefits do outweigh the risks and continued efforts will be made to monitor the health of Americans. At this point, I believe we can clearly communicate potential cardiovascular outcomes with our patients to help them make an informed decision.

References

  • Vaccines and related biological products advisory committee meeting. FDA briefing documents. Pfizer-BioNTech COVID-19 vaccine.
  • Epstein SE, Zhou YF, Zhu J. Infection and atherosclerosis: emerging mechanistic paradigms. Circulation. 1999;100:20-28
  • Syrjanen J. Infection as a risk factor for cerebral infacrtion. Eur Heart J. 1993;14:17-19.
  • Collins SD. Excess mortality from causes other than influenza and pneumonia during influenza epidemics. Public Health Rep. 1932;47:2159-2168.
  • Smith SC Jr, Allen J, Blair Sn, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update. Circulation 2006;113:2363-72

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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COVID-19 and Historical Distrust

As a member of the AHA FIT programming subcommittee, I could not have been more excited about the upcoming scientific sessions meeting. The planning for this meeting began many months in advance with lots of zoom sessions, emails, and organizing to help lay the groundwork for a successful event. As a new member of the committee, I was excited to facilitate the preventative cardiology fireside chat and the racism in medicine discussion.

However, two days prior to the session, I woke up with a terrible headache and I generally felt unwell. Considering the ongoing pandemic, I was concerned that I may be infected with COVID-19. Over the next twenty-four hours, my symptoms worsened and the following morning I tested positive for the virus.

As my illness progressed, I experienced all of the common reported symptoms: myalgias, headaches, cough, shortness of breath, and fevers. The fatigue persisted despite adequate rest. The barking cough was painful, and the constant fevers were so agonizing. The onslaught of symptoms persisted throughout my time in quarantine, and the experience was extremely debilitating. Moreover, Instead of conversing with amazing and thoughtful leaders in the field of cardiology as previously planned, the virus forced me to focus on my own physical well-being.

One of the more insidious, yet profound effects, of the COVID-19  infection, is the effect it has on your mental wellbeing. As a physician who manages COVID patients, I am uniquely sensitive to the dramatic and acute trajectory the disease may take. Being isolated in quarantine for 10-14 days, while intimately perceiving every symptom in fear, was a distinctly stressful symptom of COVID that I could have never predicted. I was confronted with my most crippling fear of progressing to critical condition and needing to be hospitalized. Regardless of the fact that I am a physician, I stared in the face of the reality that as a black man, I have a greater chance of worse outcomes.

The pandemic has further highlighted the disparity in care that exists in this country among different racial and ethnic groups. A recent publication reviewed the American Heart Association (AHA) COVID-19 registry of race and ethnicity data, which included 7,868 hospitalized patients across 88 registry sites from Jan 1 to July 22, 2020, revealed an over-representation of Non-Hispanic Black and Hispanic patients, which accounted for >50% of hospitalizations [1]. Further, these minority patients were significantly younger than patients of other ethnicities at the time of hospitalization [1]. The disproportionate rates of COVID-19 illness, hospitalizations, and death in Black and Hispanic communities are linked to several structural risk factors including living in crowded housing conditions, working in essential fields, Inconsistent access to health care, chronic health conditions, and chronic stress.

This specific health disparity is just one example of the striking effects of structural racism, years of distrust in healthcare, and lack of physical representation in the medical field on healthcare outcomes in this country. What is more alarming, is that even with the availability of a safe and effective vaccine, the historical pretext of racism in healthcare will delay and prohibit mass vaccination among many vulnerable minority populations. In a recent Kaiser Family Foundation poll, half of Non-Hispanic Black adults are not planning to take a coronavirus vaccine once one becomes available, even if scientists declare it safe and if it is available free of cost [2]. Among Non-Hispanic Black adults who say they are not planning to get a vaccine, nearly 40% cite safety concerns, including that it will be too new and assume insufficient testing [2]. Another 35% attributed their concerns to a general lack of trust or have doubts about the government or the health care system [2].

If we ever hope to get back to some sense of normalcy, herd immunity secondary to general vaccination needs to be the utmost priority among healthcare professionals. Overcoming the understandable barriers of distrust that exist in the minority community will not happen overnight. However, consistent efforts to understand, relate, and effectively communicate with patients of color can slowly help to assuage fears about vaccinations and create positive relationships between the healthcare system and the most vulnerable communities that are often ignored.

So I ask the question, what can you do as a healthcare provider to better understand and address these hurdles and to help encourage acceptance of the COVID-19 vaccination?

 

References

  1. Rodriguez F, Solomon N, de Lemos JA, Das SR, Morrow DA, Bradley Smet al. Racial and Ethnic Differences in Presentation and Outcomes for Patients Hospitalized with COVID-19: Findings from the American Heart Association’s COVID-19 Cardiovascular Disease Registry. Circulation. 2020 Nov 17. Doi: 10.1161/CIRCULATIONAHA.120.052278. Epub ahead of print.
  2. Hamel, L., Muñana, C., Artiga, S. and Brodie, M., 2020. KFF/The Undefeated Survey On Race And Health. [online] Kaiser Family Foundation. Available at: <https://www.kff.org/racial-equity-and-health-policy/report/kff-the-undefeated-survey-on-race-and-health/> [Accessed 16 December 2020].

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Gratitude on Our Worst Days

My dad desperately tried to get a hold of me on the morning of December 1, 2020 but for some reason, I hadn’t seen that he called me and so I found out my aunt, Dr. Somaya Saad Zaghloul, succumbed to COVID-19 via my mom and aunt’s medical school classmate on Facebook Messenger. Exactly what my dad was trying to prevent. I called my parents immediately and the tragic news was confirmed. We were desperately praying since her admission to the hospital that she would be one of the lucky ones, but that morning, God had other plans. I in turn desperately called my brothers and sister so that they wouldn’t find out through social media as I had and in comforting them through my tears, I reminded them that Aunt Somaya was diagnosed with rheumatoid arthritis at age 17 and that during the last several years her pain was debilitating. She needed a wheelchair to get around when her legs couldn’t carry her very far, but despite that, she was teaching her medical school courses up until she was diagnosed with the cruel virus; now, she was no longer in pain. The epitome of grace, of resilience, of living life to the absolute fullest, of smiling through your struggle, of generosity, of welcoming everyone into your home, of always looking like a million bucks (bright red lipstick and all) even if you weren’t feeling like it, of loving deeply, and of being grateful for every blessing. She was legendary.

Another cruel reminder to be grateful for everything we’re blessed with, the big things, the small things, and everything in between; the things we take for granted every day like waking up with a roof over our head, food on our table, clothes on our back, a sound mind, legs that carry us, and the ability to go to work. Every morning I wake up with a routine that includes prayer and meditation, exercise, listening to the previous day’s The Breakfast Club episode, setting my intention for the day, and importantly, writing down at least 1 thing I am grateful for and I make it something specific. My morning power hour gets me through the toughest days and makes the best ones even more fabulous, it keeps me grounded. Gratitude, when practiced regularly improves mental wellness, increases empathy, reduces anger, increases happiness and satisfaction, improves self-esteem, and best of all, helps you sleep better. I highly recommend including it in your daily routine either every morning or before you sleep at night. The practice has changed the way I view the world and how I deal with its curveballs.

Every Christmas, I request to be on call on the inpatient Heart Failure and Transplant service to honor the death of my uncle, Dr. Ali Saad Zaghloul, from a massive heart attack on December 25, 2016, a tragic death I first found out about ironically via social media. Now, I will be honoring both my aunt and uncle every December for the entire month by feeding the less fortunate, by working the holidays so others who celebrate can spend time with their families, by remembering to always be kind and forgiving, by living each day like it were my very last, and most important, being there for patients who need the most support during their most vulnerable moments.

I hope we take the lessons 2020 taught us into 2021. My biggest lesson remains that human connections are the most important thing in this world. I wish you a safe, socially distanced, and serene holiday season. The light at the end of the tunnel is not so far away anymore, we’re almost there. I’m sending an overabundance of love and light to everyone who needs it right now. The souls who’ve departed us far too soon will live on forever through all those they touched.

Drs. Ali and Somaya Saad Zaghloul

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

 

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#AHA20 and#COVID-19: Late-breaking science insights from the AHA COVID-19 registry

The American Heart Association (AHA) COVID-19 registry, leveraging the existing AHA Get With The Guideline (GWTG) platform, was developed to better understand hospital outcomes and adverse cardiovascular complications for patients with COVID-19.

The registry was formulated to accelerate the pace of COVID-19 research and quality improvement, where granular data were collected and analyzed at an unprecedented pace, shortening time to discovery and dissemination of results. As of November 9, 109 sites across the United States had enrolled over 22,500 patients in the registry. Data derived from the registry provided for some interesting results, presented at the late-breaking science session 7 at AHA Scientific Sessions.

Cardiovascular risk factors: The vast majority of hospitalized COVID-19 patients had cardiovascular risk factors, with only fewer than 15% having no traditional risk factors. Hypertension predominated (~60%), followed by diabetes (35%) and notably, obesity (45%).

In-hospital cardiac complications: The registry predominantly found that in-hospital cardiac complications occurred less frequently than initially feared, with the cardiovascular (CV) composite of complications (including CV death, myocardial infarction [MI], stroke, heart failure and shock) occurring in approximately 8.8%. Individual CV complications occurred as follows: MI ~3%;  stroke, heart failure, and shock ~2%. Myocarditis was uncommon, occurring in 0.3%. Deep vein thrombosis (DVT) and pulmonary embolism (PE) occurred in 3.8%, substantially lower than those reported in prior single center reports.

The death occurred in ~19.5% in total, with respiratory causes predominating (72%) and only 10% being attributed to a cardiac cause. 18% had other causes, commonly sepsis. The need for mechanical ventilation was ~20%.

Racial and Ethnic Differences in Presentation and Outcomes for Patients Hospitalized with COVID-19 [1]

Race and ethnicity data of 7,868 hospitalized patients across 88 registry sites from Jan 1 to July 22, 2020 revealed an over-representation of Black and Hispanic patients, who accounted for >50% of hospitalizations. They were significantly younger than patients of other ethnicities at the time of hospitalization. Hispanics were more likely to be uninsured.

The longest duration from symptom onset to hospital arrival and a diagnosis of COVID was observed in Asian patients, who also had the highest cardiorespiratory disease severity at presentation.

There was a significant burden of CV risk factors among black patients with obesity (49.3%), diabetes (45.2%), and hypertension (69.9%) being the highest reported prevalence across ethnic groups.

Mortality: The overall mortality in this dataset was 18.4% with a total of 1,447 deaths, among which, 53% occurred among Hispanic and Black patients. However, after adjusting for sociodemographic, clinical, and presentation features, mortality and major adverse cardiovascular or cerebrovascular events did not differ by race/ethnicity.

Nevertheless, given the greater burden of mortality and morbidity of Black and Hispanic patients, the authors recommended that interventions to reduce disparities in COVID-19 be focused upstream from hospitalizations.

Association of Body Mass Index (BMI) with Death, Mechanical Ventilation, and Cardiovascular Outcomes in COVID-19 [2]

In an important analysis looking at the association of BMI with COVID-19 outcomes, this study found that obesity, and particularly class III obesity, is over-represented in the registry among patients of COVID19, with the largest differences observed among adults < 50 years. Higher obesity class associated with younger age. Higher BMI class was also associated with a higher prevalence of the black race.

Among 7606 patients, the composite primary endpoint of in-hospital death or mechanical ventilation occurred in 2109 (27.7%) patients. After multivariable adjustment, classes I to III obesity were associated with progressively higher risks of in-hospital death or mechanical ventilation. Significant BMI by age interactions was seen for all primary endpoints. There was no association between obesity class and major adverse cardiac events (MACE). As for venous thromboembolism, Class II obesity was associated with a composite higher risk of venous thromboembolism.

Severe obesity (BMI ≥40 kg/m2) was associated with an increased risk of in-hospital death only in those ≤50 years (hazard ratio, 1.36 [1.01–1.84]). In light of these findings, the authors underscored the importance of clear public health messaging and a rigorous adherence to COVID-19 prevention strategies in all obese individuals regardless of age, but especially those <50 years who may underestimate their risk for COVID-19.

The entire session can be viewed on-demand until the 4th of January 2020: AHA Goes Viral: COVID-19, Influenza Vaccines, and Cardiovascular Disease. Both the above studies were also simultaneously published in Circulation.

References:

  1. Rodriguez F, Solomon N, de Lemos JA, Das SR, Morrow DA, Bradley Smet al. Racial and Ethnic Differences in Presentation and Outcomes for Patients Hospitalized with COVID-19: Findings from the American Heart Association’s COVID-19 Cardiovascular Disease Registry. Circulation. 2020 Nov 17. doi: 10.1161/CIRCULATIONAHA.120.052278. Epub ahead of print.
  2. Hendren NS, de Lemos JA, Ayers C, Das SR, Rao A, Carter S. Association of Body Mass Index and Age With Morbidity and Mortality in Patients Hospitalized With COVID-19: Results From the American Heart Association COVID-19 Cardiovascular Disease Registry. Circulation. 2020 Nov 17. doi: 10.1161/CIRCULATIONAHA.120.051936. Epub ahead of print.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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The Era of Misinformation: A Constant War of Science vs. Fiction

“Covid19 is a hoax”, “vaccines poison your body”, “the earth is flat.” Various conspiracy theories and misinformation statements have existed throughout history. Though some might seem absurd and often put into the spotlight to ridicule them as they are improbable to be accurate, like the earth being flat, this comedian aspect shifts to a sinister black connotation when the conspiracy theories, and misinformation infect the medical field.

As the first doctor of my family, it is not uncommon to get questions about a new drug that was promoted on TV, or regarding a bold scientific claim, such as someone curing cancer. However, during this year, amid the Covid19 pandemic, the spread of misinformation has been almost as incontrollable as Covid19 cases in the United States of America. With great concern, I saw that several acquaintances, friends, and family, most of them with higher education degrees, shared and contributed to spread false information on the treatment of Covid19, its origin, or questioning if this was part of a bigger plot to control humanity.

The spread of misinformation has contributed to mistrust towards medical healthcare personnel, to the point of being violent towards them,1  not following their advices, or falsely claiming overdiagnosis of Covid19 with the sole purpose of getting “more money,” claim that unfortunately gets backed up by the Highest Office in the Land.2

However, this problem isn’t new in the medical community, as Dr. Anne Marie Navar stated in her conference during the Scientific Sessions lecture “How Misinformation Steers Patients off Course.” She mentions that the Covid19 pandemic highlighted and made more evident the dire problem misinformation has brought to medical compliance with treatments. She focuses on the misinformation campaigns that have been occurring around statins, were social media personalities with doubtful medical claims such as the questionable Dr. Joseph Mercola, and unscrupulous social medial like Infowars pretend to scare and deter patients from taking statins, while promoting their products such as diets, supplements (Omega-3), that are commercialized with misleading labels, and lies about the efficacy of their products.

But how likely are statements made by doubtful doctors or non-healthcare providers likely to affect patient compliance? Would patients believe more something they read or see on social media than following the physician’s recommendations to whom they trust their health?  Unfortunately, it is quite likely. Dr. Navar highlights a prospective cohort study from Denmark that included 674.900 individuals > 40 years old, that were on statin therapy ( a drug used for patients with high cholesterol levels) from 1995-2010, and followed until December 31 of 2011, to test the hypothesis if statin-related news were associated with early statin discontinuation.3

This prospective cohort showed that early statin discontinuation increased with negative-statin related news, and early discontinuation was associated with increased risk of myocardial infarction and death from cardiovascular diseases (fig 1). Also, a sensitivity analysis showed that  negative statin-related news stories were associated with an odds ratio of 1.15 (CI: 1.09-1.21) for early discontinuation of antihypertensive medication (fig 2).3

Fig 1. Early statin discontinuation vs. continued use and cumulative incidence of myocardial infarction (top panel) and death from cardiovascular disease (bottom panel).

Fig 2. Statin-related news stories and early discontinuation of statin, antihypertensive medication, and use of insulin among statin users.

It is worrisome that patients’ very own life might be at stake due to misleading propaganda that feeds from the fear of exaggerating adverse events for specific treatments (drugs, vaccines, etc.). To have these very own propaganda makers, in an ungracious second act, pretending to be messiahs, to promise patients the “healthiest” option available for their disease, thus creating widely successful businesses by selling non-effective products at the expense of putting the populations’ health at risk.

But this misinformation phenomenon has been more impactful and dreadful during the pandemic since we are dealing with a highly transmissible disease, where the cost of disinformation results in more people getting infected with Covid19 ,or dying because of Covid19.

But what can we do as healthcare professionals?  As scientists? The first thing to do is to speak up. We must not be silent as false and misleading information spreads. The truth tends not to be soothing, hopeful, nor easy to process, and during this cumbersome year, this might become a more challenging task when coming to terms with “the new normal.” The evidence does not change because of our feelings, thus making it imperative to face the facts. Our role as physicians, healthcare workers, and scientists is to be modern versions of Prometheus, and reside on the frontline to fight back misinformation by being leaders that defend the torch truth, and share it with the world.

Dr. Anthony Fauci is the perfect example of the leadership we all must show as bearers of the torch of truth, as his statements are based on hard facts and science.  Nonetheless, his remarks often failed to reassure people during these unprecedented times since he has been very cautious by avoiding making any premature conclusions regarding the effectiveness of a treatment or on the efficacy of a vaccine without proper evidence, as it should be.

However, this lack of reassurance opens a door for opportunistic scientists and medical doctors such as America’s Frontline Doctors, that earlier during the year claimed that Covid19 could be treated with hydroxychloroquine, widely tested as being not useful.4,5 This bold claimed amid the uncertainty lived in the beginning of the pandemic, unleashed an incontrollable confirmation bias, as people would feel reassure when “doctors” tell them there is a cure for this virus; despite the fact that the “doctors” making such claims were not infectious disease experts, nor did they have any real evidence to support those claims. This mere example highlights the importance of raising our voices to spread real facts to prevent landslides of false information spread.

We must be empathetic to those that are sharing or commenting on false information. When seen friends or family doing this, please give them the benefit of the doubt, as people share information thinking of their well-being and that of others and, most of the time, is not out of a primary motive to harm or do wrong. When I have encountered my family or friends doing this, I try to reach out to them and ask them what they learned from the information they are sharing and explain to them the inaccuracies of all the misleading content on the news they are spreading. At last, I tell them to send me privately all the videos, chats, news they get so we can discuss them before sharing them. By doing this, the fake news chain will break, and more people will start acquiring critical thinking before sharing news from a field that is unknown or unfamiliar to their area of expertise, in this case, medical and healthcare related news.

Finally, I would like to share a pamphlet on how to fight misinformation from Dr. Tim Caufield from the University of Alberta that outlies four main steps, help stop the spread, and craft a message to counter misinformation, promote a regulatory response, and debunking (fig 3).  Let us all unite our voices so they can be loud enough to bury misinformation.


Fig 3.  Fighting misinformation pamphlet (https://www.ualberta.ca/law/faculty-and-research/health-law-institute/fighting-misinformation.html)

Acknowledgments
I would like to thank Dr. Anne Marie Navar for her conference “How Misinformation Steers Patients off Course” As it encouraged me to write todays blog on this pressing issue. I encourage you all to see her conference on the Scintific Sessions website.

References

  1. Medellin. Personal médico del Hospital General fue agredido por caso de covid-19. El Tiempo. https://www.eltiempo.com/colombia/medellin/coronavirus-en-medellin-denuncian-agresion-a-personal-medico-del-hospital-general-de-medellin-527090. Published 2020. Accessed.
  2. Griffin J. Medical professionals push back after Trump says COVID-19 cases are inflated to ‘get more money’. Daily Herald 2020.
  3. Nielsen SF, Nordestgaard BG. Negative statin-related news stories decrease statin persistence and increase myocardial infarction and cardiovascular mortality: a nationwide prospective cohort study. Eur Heart J. 2016;37(11):908-916.
  4. Boulware DR, Pullen MF, Bangdiwala AS, et al. A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19. New England Journal of Medicine. 2020;383(6):517-525.
  5. Effect of Hydroxychloroquine in Hospitalized Patients with Covid-19. New England Journal of Medicine. 2020.

 

 

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WELLNESS MATTERS

American Heart Association Early Career Guest Blog

Sherry-Ann Brown MD PhD FAHA

WELLNESS

The World Health Organization defines wellness as “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity”. The terms in this definition inspire similar words such as continuous (state), whole (complete), tangible (physical) and intangible (mental), as well as togetherness or community (social).

 PANDEMIC WELLNESS

Indeed, during the pandemic, we often say or hear, “We are all in this together”. The global community has rallied around each other to get through the coronavirus disease of 2019 (COVID-19) well. In the midst of a nation in turmoil with pandemics juxtaposed (coronavirus and racial and ethnic inequities), we find ourselves in the middle of it all as physicians.

SAFETY & WELLNESS

Along with everyone else in medical authority, we encourage those around us and all we serve to distance physically more so than socially. We want people to remain social, to enhance wellness. Yet, we need that socialization to be safe and physically distant, to foster tangible wellness.

 WELLNESS NOT CANCELLED

We encourage everyone to recognize that conversations, relationships, love, songs, reading, hope, joy, getting outdoors, music, family, and self-care should not and will not be canceled. This is the good stuff. The intangible components of wellness.

WELLNESS HEROES

So many of us in health care are sacrificing this period of our lives or in fact our very lives so that our patients can be whole. This altruism that led us here is continuous and indestructible by the #rona. Many of us turn to visual wellness inspired by COVID-19 to help capture the essence and sentiments of these challenging times. Art and other forms of creative expression of what’s inside of us or in society can motivate us to see more, be more, and serve more.

These matters at hand are crucial to help maintain our state of complete physical, mental, and social well-being. If we are honest with ourselves, we recognize that most of us live at best in a state of incomplete well-being. Yet, we can stand together against cancellation of our will and empower each other on this journey to wellness. It’s never been a destination. It’s always been a process that we continue to learn daily.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Work life balance- Is This a Myth?

Work-life balance: for many in Cardiology it’s an elusive idea. Now, our worlds of work and “life outside of work” are even more blurred among Zoom meetings and facemasks.  However, over the years, I have learned 3 important concepts (Figure 1) that has made work-life balance POSSIBLE, not just a myth.

Figure 1. Outlining the three key concepts of work-life balance.

Concept #1: Who are you outside of work?

As Cardiologists, researchers, educators, and team members we know the day, night, and weekend hours that define our careers. However, how do you describe yourself outside of work? Who are “you” after shedding the scrubs and white coat, away from the office, hospital, and lab?   Beyond Cardiology, what are your interests?  The answers to these questions help to define you and an important part of your life. When we lose our work-life balance, we are losing a part of ourselves.

To begin recapturing your interests, look at your calendar over the next month, and schedule small increments of time (just 5-10 minutes!) to reconnect with your personal interests (of course staying safely physically distant for now).  These baby steps will move you closer to capturing the “life” in work-life balance.

Concept #2: “Balance” is dynamic.

How do you define “work-life balance”? Is it an equal distribution of time? Is it a certain quantity of time for specific activities?

Work-life balance is very similar to the field of Cardiology – it is constantly changing. For most people, work-life balance will not mean that there is “equal” or balanced time between work and personal life. Especially in Cardiology, our job usually engulfs the majority of hours in a week – clinical duties, grant deadlines, presentations, emails… and the list continues.  However, for work-life balance, one of the goals is to “balance” the transition from work to “life outside of work”. This means your presence, attention, and focus should completely shift from work to your personal interests and interactions. Work-life balance is beyond physically leaving the job, but balancing the mental transition to fully shift away from work.  It will take practice to avoid checking email or mulling over work.  The amount of time between work and your personal life will remain dynamic; but the “balance” is your ability to commit your focus and attention to those precious personal moments, just as you do for work.

Concept #3:   You are Responsible for You! 

Cardiology requires you to constantly learn and practice to achieve and maintain competency. You are upholding a professional commitment. The same commitment is required to grasp work-life balance.  You have to make a personal commitment to you!!  It is not sufficient to just “wish for it”.  We cannot expect anyone else to understand our needs or create our work-life balance.

To reframe this important concept, consider your self-care and work-life balance as critical as filling your car with gas (or charging your car):  you cannot function without it!  Your personal commitment has to be as strong as your professional commitment.   No, it’s not easy, but it is possible.  Some find it helpful to be accountable to a colleague or friend, check-in regularly (set a reminder) about small steps to promote work-life balance. We understand our responsibility to patients.  Now, it’s time understand your responsibility to you!

During these uncertain times of the COVID-19 pandemic, healthcare workers are working longer hours and under even greater stress. It is normal to feel overwhelmed. Now, more than ever, it is important to find creative ways to focus on precious moments and commit to your well-being!  Below are 5 tips to stay committed to yourself and safely connect with others:

  1. Take three minutes.  Listen to your favorite song, dance while nobody’s watching, or take a few extra minutes in a hot shower. You do not need a long time to be kind to yourself.
  2. Join a Virtual group or class.  Physical distancing and long work hours can be very isolating. Take advantage of the numerous virtual options to safely connect with others who have similar interests.
  3. Share and listen.  Try moving beyond texting and talk on the phone. Commit to that moment, engage in the conversation and focus on listening.  The human connection remains very powerful to strengthen our mind and body.
  4. Protect Your Time. I know it is easier said than done. However, learning to set boundaries is critical to sustain your commitment to work and participate in the joys of life.
  5. Be Kind to Your Body. Find time to sleep, eat healthy snacks, and participate in small amounts of physical activity. Mental health and physical health are equally important.

In summary, work-life balance is a journey, not a destination.  Remember, that “balance” in work-life balance is dynamic – the amount of personal time will change, but your commitment and focus to that time should only grow.

 

About the Author:

Heather M. Johnson, MD, MMM, FAHA, FACC is a Cardiologist & Preventive Cardiologist at the Christine E. Lynn Women’s Health & Wellness Institute at Boca Raton Regional Hospital/Baptist Health South Florida.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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From Race-Based Medicine to Fighting Structural Racism

“Race is the child of racism, not the father.”

-Ta-Nehisi Coates, Between the World and Me.

BiDil, a combination of isosorbide dinitrate and hydralazine, was approved by the FDA in 2005 to treat heart failure in African Americans— the first race-based indication in the U.S. Though some groups lauded this move as a win for the underserved Black community, controversy soon emerged— and rightly so. Why did the researchers come to the conclusion that this combination of drugs worked better for one racial group than another? Why did the FDA take the action to approve it this way? The answers were not reassuring.

Did you know that there is no genetic basis for discrete racial categories? If not, this is likely because of what you were taught in training. It’s time to unlearn some falsehoods! The concept of race is not, in fact, biological, but social. It is not race, but racism that creates and perpetuates inequities.

Race-based medicine is bad medicine. Period. Dorothy Roberts gave a seminal TED talk in 2015 explaining this concept. The persistent myths that characteristics like pain tolerance vary by race are damaging and false. It is up to us, as clinicians and scientists, to dismantle the racist structures and processes within health care and within our larger communities that harm people of color. We cannot allow the fiction of biological racial difference to obscure the reality of racism.

Race can be an important variable to include, analyze, and understand in science and medicine, but not because of biology— because of structural racism. Diagnosis and treatment should not differ by race. Rather, social determinants of health must be part of all the care we provide, and all the research we conduct. We need to fundamentally reexamine the characteristics we use to ensure diversity and external validity. Yes, we need data on race, that that’s not enough.

As we see stark and alarming differences in COVID-19 among racial groups, the realities of racism’s health impacts are writ large. Living and working conditions, rather than biological differences, drive the differential infection and death rates. We, as the next generation of scientists and clinicians, can seize this moment to create lasting change and move toward health equity.

How?

  • Question assumptions. Race-based decisions in medicine are often due to force of habit, tradition, and education. Ask why and if there’s not a good reason, stop. Why do we give race as a defining characteristic in our case presentations? Why do we calculate creatinine clearance differently? Why do we prescribe differently?
  • Assess your biases. Try the Harvard bias test, for example. No one is without bias! Seek out training. Eradicate blind spots. Form accountability groups with colleagues. This work can be uncomfortable, but it’s necessary.
  • Solicit input. Whether you are a researcher or a clinician, the community you serve needs to be involved. Do not assume you always know what’s best. If you ask, and listen, you will discover the values and priorities of the community. Trust-building takes work and time. Demonstrate trustworthiness and remember that iatrophobia is justified by history.
  • In research, define race and specify the reason for its inclusion. Use a sociopolitical rather than biological framework, and name contributing factors. Name racism and related forms of oppression that may be operating[1].
  • In clinical care, assess and address social determinants of health. Advocate for equity-focused community practices: food banks, suspension of evictions, support for access to broadband internet to increase access to healthcare and education, and provision of paid time off for sick leave & quarantine, among other actions. Identify needed resources and provide them.[1]

 

Sustainable change is never straightforward, never easy, and rarely rapid. As early-career professionals, we have many years to fight this fight. Let’s not waste any of them.

 

References:

[1]Boyd, R., Lindo, E., Weeks, L., & McLemore, M. (2020). On Racism: A New Standard For Publishing On Racial Health Inequities. Health Affairs Blog.

https://www.healthaffairs.org/do/10.1377/hblog20200630.939347/full/?utm_medium=social&utm_source=twitter&utm_campaign=blog&utm_content=Boyd&

[1] Haynes, N., Cooper, L., & Albert, N. (2020). At the Heart of the Matter: Unmasking and Addressing the Toll of COVID-19 on Diverse Populations. Circulation, 142 (2).

https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.048126

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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A New Way To Participate

One of the characteristics of attending medium to large scientific sessions is the time-honored act of… running from room to room trying to catch glimpses of talks that interested you, but have of course ended up in different rooms, minutes apart. Many of us have done this, and to an extent, I don’t mind it! I can always count on being able to reach my daily step count targets whenever I’m attending a conference, without needing to set aside 30mins dedicated to a walk or morning run.

The current global health crisis has ushered in new and accelerated inevitable changes in the way science research is conducted, disseminated, and discussed within the community. Each one of these aspects has shown the malleable and highly valued ability for science, and society, to adapt to new paradigms of work. There have been many challenges and losses in the way research has been affected (a partial or total work-from-home status doesn’t translate to equal productivity for lab based work). But at the same time, this ongoing pandemic response has also provided a launching pad for some very innovative and future friendly adjustments.

Today I’ll focus on one of those changes, related specifically to conference attendance. This is by no means a novel idea, but I find myself thinking a lot about it, and I’d like to share some of those thoughts. Online based conferences have existed before Covid-19 became a house-hold idea and reality. Even more novel are Social Media “conferences”, an example being the Royal Society of Chemistry putting on the #RSCPoster Twitter Conference earlier this year (planned in early 2019, before covid).

The fact of the matter is, the movement to have scientific meetings and conferences be better adjusted within the online space has been gathering momentum for years. I for one, have served as “Twitter Ambassador” for a handful of conferences over the past couple of years, because conference organizers, participants, and various communities, have found tangible and positive effects of having conferences be more open, interactive, and far-reaching, beyond the walls of the hotel or center that brings together the in-real-life attendees.

(photo taken by Mo Al-Khalaf, 2020)

This year the Basic Cardiovascular Sciences headline annual meeting, better known this week as #BCVS20 is a fully virtual conference. As an early career molecular biologist researching mechanisms of heart disease, this is one of the “can’t miss” events on my calendar. My previous experiences for these type of conferences has been very rewarding, and advantageous in propelling my research and career. Before Covid-19, I was very much looking forward to this meeting scheduled to be in Chicago. When it was announced that the meeting will become fully virtual, I knew that there will be some experience that’ll get lost in the format change. But I also appreciated the diligent and effective leadership that made this call, because this was definitively the right call, for the safety of the attendees, and all the workers that would be involved in administering and pulling off a successful meeting (a meeting that brings 1000+ folks, in one building for a few days).

So far, I must say I find the #BCVS20 experience to be quite rewarding. It is different, and the limited and reformatted ways of networking and engagement takes a little bit of time to get used to. But overall, I believe there is great potential to make this format, or better yet, a hybrid format where both online and in-real-life parallel options available, a very appealing and appropriate next step in the evolution of how these types of meetings can be conducted. The ability to cater to a worldwide audience, and the convenience provided to allow attendees to participate and learn from field experts without the difficulty of planning a trip, is without a doubt an advantage to students and early career professionals, who do frequently face difficulties in attending such meetings.

One thing I note: Unlike past conference going experiences, I definitely need to put in the 30-minute daily jog before or after the day’s sessions… because there is no need to run from room to room to catch talks that you’re interested in… it’s all just a mouse click or head turn to a second screen away!

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”