(Guest Lecture): Lessons Learned in New Mexico | MCRT Webcast: Experts Discuss COVID-19 and Myeloma

[Music] you from dr. Jagannath we heard what it was like in a quote unquote hot zone you are not in one of those quote-unquote hot zones so how are you dealing with this how are you preparing and for a possible increase and what are some of the lessons that you've been learning from colleagues like dr. Jagannath well that's exactly right we haven't had this overwhelming pandemic like we've had in New York in China and Italy so we have been looking very closely at the experiences in those locations and trying to act proactively to do what we can to to minimize the amount of infections so it's it's really first of all I'd like to thank you for for getting this all put together because we were having those conversations about having people come out to New Mexico and when you asked me in February should we be bringing people out we already had a travel ban in place so I'm impressed that you were able to put this together and it's a very timely topic because it's a big part of what we're doing every day even with our myeloma patients they're constantly asking what should we be doing and how does this impact us and then we have some more subtle conversations about what to do with their treatment and whether there should be changes made the American Society of Hematology has also made recommendations for individual different diagnoses and their specific recommendations for myeloma so we're taking a look at those things as well but also considering where we stand in this it is very dynamic it changes week by week so we assess what our resources are in the clinic we've made changes there to make people safe we assess our inpatient resources and that's changed a lot too and I can get into that a little bit so we're we are definitely trying to learn from the experiences of others so that we don't have to repeat all of that here in New Mexico that being said it's expected that our peak number of cases will be in the next few weeks so we're sort of seeing how that will play out all of us sub specialists in hematology and oncology we've been asked to we've sort of been draft to cover the cover inpatient services should they become overwhelmed there and so we sort of out we're on a list of you know to help take over right now it's kind of like the calm before the storm in a sense or maybe if you think about a tsunami there they say the water goes out first before the tidal wave hits and and that's true because you know a lot of people have been staying away from clinic we've been doing a lot of telemedicine which was is really sort of a new thing and in the hospitals a lot of elective cases and surgeries have been cancelled so the hospital sort of cleared out which was actually quite a benefit because our UNM hospital is a County Hospital it typically runs over capacity and I really was worried how that would how we would manage an influx of patients but the fact that the census went down really increased our capacity and and so I think we're actually in a good situation and I expect we won't become overwhelmed okay that's that's that's promising news certainly and we hope other colleagues in your positions are gonna are gonna face the same things now you as a year you treat myeloma you're also bone marrow transplant specialists how do you deal day to day with people who have active myeloma during this time they may need a stem cell transplant they may need infusions what are some of your strategies that people should be thinking about and and how flexible should they be it's it's very much individualized so there's not one solution for everybody and I think that was a question in the QA that I answered as well the question was should folks with myeloma do something different than other patients well there's that there's you know this has been changing with the recommendations for the general population it has changed you know first there were travel restrictions and that now there are stay-at-home orders here in New Mexico and so those things apply of course but myeloma varies a lot from patient to patient the status of the myeloma either may be in remission or it may be progressive and you need treatment the general recommendations from the American Society of Hematology is not to hold treatments but definitely considerations need to be made there are some treatments that can be done orally where you may not need to come in to the clinic all the time for infusions and we're doing more of that we have postponed all of our bone marrow transplants during this peak phase we don't want people to be in a hospital at the hospitals overwhelmed we don't want them to be exposed but also after a bone marrow transplant you develop a you develop a lymphopenia a lobe low lymphocyte blood count that lasts for several months even though the recovery is quicker in terms of neutrophils and your red blood cell count that low lymphocyte count may be a risk factor for bad outcomes with with koban 19 that's been shown a number of studies out of China and elsewhere and so we don't want to put a patient into a situation where they would be at increased risk right when there's a lot of the virus present that's a little different than some other treatments so there are other treatments that you can do as an alternative that may not knock that lymphocyte count down so much and so that's what we would consider and generally speaking the timing of a transplant is pretty elective even though it's a standard treatment and we still recommend it it's not essential but it typically that happens immediately so we will collect stem cells put them in storage and then we'll decide when the best time is to proceed okay now I've been like as I said it before I'm so interested in the type of research you do and your research in particular focuses particularly on molecular minute mechanisms and cells and how they go awry and organ tissues and to me as a layperson looking at the effects of kovat that sounds fairly familiar is there any overlap between the type of research that you're doing now that can inform kovat research well I'm not an infectious disease specialist we do we do laboratory research on the pathogenesis of malignancies but I actually do have just coincidentally some collaborative work that's ongoing with infectious disease doctors at the University of Washington where this was sort of the original episode enter in the country we are actually testing antiviral drugs to see if they may increase the risk of susceptibility to certain cancers so there's some indirect connections there but I can't say we're directly working with kovat 19 I've kind of become a little bit more informed about antiviral drugs so I've been interested to hear about the this research coming out with a cocktail of antivirals that may be beneficial at eradicating the infection or speeding the eradication in code 19 patients as dr. as dr. Jagannath indicated I think it's remarkable that we haven't seen a that cancer patients per se or at a remarkable increased risk that may be for lack of data but but there's also some other surprises with people with cardiovascular disease and diabetes obviously pre-existing pulmonary disease is a problem since this is a respiratory infection but those other paints so there may be a cardiovascular component to the disease as well where the the the heart or blood vessels get involved and get infected we know patients with the most severe disease they have a very Mia the virus is in the blood it gets into the gut doctor Dragunov mentioned patients having diarrhea etc so it can in the in the most severe cases it becomes systemic it's not all just about the lungs and the Airways I had a conversation with dr. Ali Wadi Ali will Heidi Whaley Wadi in Maher Jacksonville a couple of months ago about how we knew that there were that this pandemic would expose health disparities and and it has and in in New Mexico you have really some unique types of health disparities in terms of Latino communities Native American communities and especially rural people who live in extreme rural conditions can you tell us how you deal with that well that's absolutely right so thank you for bringing it up here in New Mexico the the the most cases are in the metropolitan area of fair Leo County which is where Albuquerque is located but that's not surprising because that's nearly half the population of New Mexico however if you look per capita there's really been a disproportionate number of cases to the west and northwest which is up into the Navajo Nation and there's there's about three times as many cases there and fatalities and that definitely is a resource poor area they have less access to care they live and oftentimes in smaller dwellings more people per dwelling and then the cultural practices may impact that as well I have a patient who lives on a local Pueblo who said it just now hit their Pueblo and a lot of cases were thought to have occurred because of a funeral where the whole of Pueblo had gathered and you know and apparently a lot of people had gotten exposed so that's that that's definitely a big problem I was just on the the Indian Health Services website earlier and I can see that they really are doing an admirable job of trying to address this they're tracking the number of cases how many deaths and really trying to provide information for that community in particular we are used to people having to come long distances I when I was a resident the Mayo Clinic people would come from all over the all over the world here they people are used to getting in their cars and driving long distances so we are managing a lot of that with telemedicine now which helps minimize people's need to come into clinic possibly get exposed and in myeloma you can do a lot of that if you can get a decent blood test on them check their blood work and their myeloma markers then in the short term at least you can really do a lot without having to having to expose people okay then I have two sort of unfair questions that I that I've heard a lot from patients so I'm gonna go ahead and pose them what do you wish you knew two months ago knowing what you know now and and then take out your crystal ball and and how do you see what do you what are some of the things that you're thinking about that might be our world six months from now our world meaning the myeloma community well yeah you know two months ago back in February I you know I think I'm like a lot of us I probably minimize this thinking uh yeah this is you know this is in Italy and this is Europe and in China you know maybe we'll maybe we it'll miss us it'll pass by or what have you I don't think that we were completely naive oh we were paying close attention to things and a lot of preparations were being made and as soon as information came out we really tried to take that to heart and we've thought a lot about where you know where do things go from here I think one of the big questions I have and I don't see I don't think there's been enough attention paid is to is how do we get out of the certain situation you know like where do we go from here one big thing of course that's happened I think nationwide is that people are in their governor's or their states that said that they should stay at home that's a huge economic cost and it's not a long-term solution because it's absolutely effective if you're not exposed to other people but if you're still susceptible and goben and you stop this and go back into community and it's still out there then you have to have a long or term solution that can they can prevent just a resurgence of the disease one of those things of course is if people are immune if we have a vaccine people we can become naturally immune if they've exposed so in New York City you know and may have the benefit where a lot of people have been exposed and so therefore they won't spread the virus around once they've cleared it out of their system but short of that you know I really hope that we learn one thing that might come out of this is that we can learn from the myeloma community and bone marrow transplant communities how do you have proper hygiene when you're in public how can you be respectful if you have a cold and coughin and have good hygiene and not spread that to other people I'd like to see people wear masks on airplanes if they if they have a cough or sneeze I'd like to see people just be more conscientious about that and that won't just help Cova that'll help influenza and things that we're dealing with parentally I always say that you know to be a myeloma specialists you basic we go through medical school every three years of your life you're constantly in medical school when you're a myeloma specialist or or a hematology specialist what is that like with kovat I mean how much time are you able to spend reviewing literature doing what you normally do as a doctor and a researcher and how does that affect your everyday practice I feel as a myeloma doctor I'm constantly in medical school and I think one thing in medical school you learn is that you can't know it all and you have to cost you have to sort of learn how to learn and and stay apprised of what is new and and be humble and and realize you don't know everything so it's so the corona virus or kovat 19 has definitely become a major subject of all of our conversations with patients we tried to educate them I think they do have the benefit especially if they've been through a bone marrow transplant about knowing something about personal hygiene and safety and so that so they're one step ahead in that way if they are if their diseases in remission and they have normal blood cell counts I don't think that they're a particular risk compared to other patients so so I think in a way they're they're kind of a step ahead but it has become a definitely a major part of our daily communications it takes longer to get through through a discussion when you're trying to do it on the phone and and you have these additional concerns and and finally I just you know I'd like to get just a little personal because I you know you one of the things that you and I share or I should say your children and I share is is that we we have grown up firmly with one foot in the United States and one foot in Europe specifically Germany and all of our patients and all of our doctors are constantly traveling internationally when we are able to travel internationally again how do you think that's going to be different or is that something we should even be thinking about now I'm not so sure international travel versus travel in general is an issue I think that hopefully we can learn as a nation to make travel a little safer here in New Mexico there is a there is genomic specialist who has done sequencing on the corona virus that patients have had acquired and you because of this the subtle mutations that happen the virus you can actually determine his pedigree and determine where it came from and so most of the cases have been directly linked to travelers and most of those travelers were coming from Europe or New York and didn't realize that they had the infection of course and then started a little cluster of infections so I do think the travel is important and we should learn how to travel safely you know we nowadays we're all crammed into these little spots and airplanes and I'm not sure you know we always worry about the air flow in the airplane but I I hope that we can you know learn to cover our coughs and maybe have hand sanitizer and maybe wear masks in the airplane if we if we if we have URI symptoms and that can just help overall but on a personal note it is you know it is impacting us as well as a family my daughter's in Washington State so here's a shout out to Michelle who is a she is a floor nurse at the biggest Hospital in the city and her whole floor is coronavirus patients so she has you know had to learn very quickly how to how to deal with that there I think there was a lot of stress on the nurses and so I really think they should take the credit for being the ones who are on the frontline and and dealing with this every single day you [Music]