September 10, 2020

This year, the 19th anniversary of the World Trade Center attacks on September 11th is especially painful. Brave heroes from Ground Zero are facing the added risk of COVID-19 infection. Newsday reports that more than 100 individuals in the large 9/11 community have died from COVID-19. The first responders who were exposed to toxic fumes and dust contracted serious lung diseases (along with cancers, including myeloma, as we have previously written about), and are now at high risk for COVID-19.

As we honor those who served so selflessly during that tragic event, let us not forget the unintended consequences and the precious lives that are being lost.

How to Remain Safe from COVID-19

The best protections for those most vulnerable to the novel coronavirus remains a top priority. As the COVID-19 crisis reaches the six-month anniversary in the U.S., it is helpful to reflect on what we have experienced and what we have learned. Unfortunately, the truth hurts. Consider that:

• Things could have gone a lot better in the U.S., which has the poorest outcomes globally, despite the relatively abundant health care resources available.
• We are still lacking the testing, protective equipment and public health resources that we need.
• The level of COVID-19 in many communities remains unacceptably high. This means that vulnerable groups with compromised immune systems, including myeloma patients and first responders, must be especially cautious.
• Simple measures could have had a huge impact:
  • Just using masks could have reduced infection rates by 50%.
  • Using masks and introducing simple precautions (such as physical distancing, avoiding crowds and confined spaces) could have reduced deaths by 150,000, an extraordinary and now tragic number.
  • Adding rapid testing, tracing, and isolation could have reduced new cases to zero, as in New Zealand, Iceland and other countries, where careful, simple measures were implemented. (In recent days, four new cases of COVID-19 emerged in New Zealand due to failures at Border Entry; with aggressive contact-tracing the situation will come rapidly under control, in a manner that is still just a dream for the future in the U.S.)

The bottom line

The simple measures we have presented and discussed so many times here since the pandemic began are the first line of defense and will be essential in the U.S. for the foreseeable future.

What About a Vaccine for Myeloma Patients?

Will the vaccines work well for myeloma patients?

This is the $64,000 question, as we hear about all the controversy surrounding the development of COVID-19 vaccines. The case of transverse myelitis, a serious autoimmune inflammation of the spinal cord, in the Astra Zeneca vaccine trial in the U.K., is a serious concern. Appropriately, this trial has been temporarily stopped.

There are several concerns for myeloma patients:

• First, it is essential to study the effects of the vaccine in as many individuals as possible, including in older age groups and those with compromised immunity, to assess the true sustained production of neutralizing (active anti-COVID-19) antibodies. It is anticipated that at least one booster dose will be required to produce the antibody levels needed.
• As a group, myeloma patients are susceptible to “autoimmune” diseases. In many ways, myeloma itself is an autoimmune process. Thus, there is particular concern about an autoimmune reaction with the COVID-19 vaccine. The trial will need to be expanded to assess this in more detail. This is the normal procedure in vaccine development, which just takes time!

The bottom line

Myeloma patients will probably NOT be the first best candidates for vaccination until much more information is available.

Convalescent Plasma Treatment

A new report and commentary by Dr. Eric Topol again emphasize that there is marginal, if any, benefit with convalescent plasma treatment. The path forward with science is never easy. All trials are just that—TRIALS—to figure out if a treatment can help. Most trials do not work out. That is why we can truly celebrate when real breakthroughs occur. In the case of COVID-19, we are still waiting.

Remembrance and Honor

This week, as we remember 9/11, let us celebrate the spirit of the American people, who can rise to any occasion with self-sacrifice and honor. We must all do our best to stay safe in this time of COVID-19 and remember to help and protect those who are the most vulnerable. We WILL get through this together.