June 4, 2020

Today, the U.S. House Select Committee on the COVID-19 crisis, chaired by Representative James E. Clyburn, held a briefing to examine the impact of the coronavirus pandemic on existing racial health disparities. There is a well-documented unequal burden of this national public health crisis on communities of color. The hearing comes “as Americans across the nation continue to protest the racial and institutional inequalities,” according to the briefing announcement.

Pandemic statistics reveal the racial health disparities: The latest overall COVID-19 mortality rate for Black Americans is 2.4 times as high as the rate for Whites. Atlanta Mayor Keisha Lance Bottoms said that “more than 80% of those hospitalized by COVID-19 in Georgia were African American.” And, according to the Los Angeles Times, Caucasian residents of Los Angeles County have had 13 COVID-19 deaths for every 100,000 Caucasian residents. For every 100,000 Black residents there were 26 deaths. Twice as many! 

We look forward to meaningful discussions about concerns raised by many that the Federal government needs to do more to ensure communities of color receive adequate public health funding and resources. In a separate report, researchers found that racial disparities in how NIH (National Institutes of Health) grants are evaluated persist despite a 2009 change to the review process designed to alleviate these differences. This, too, deserves equal ongoing attention. 

Day-to-Day Guidance for Myeloma Patients

Despite heightened fears and uncertainties across the U.S., we must face our day-to-day challenges with as much resilience as possible. Who knew that our focus on enhancing resilience in the myeloma community would take on such a high level of importance for all Americans and the whole global community of nations. It is not easy to stop and deal with new challenges as they emerge. But it is essential to strengthen our social networking to support each other as we search for answers and positive change. 

For myeloma patients it is especially important to periodically step away from the constant barrage of negative information and focus on achieving personal sanity. What works for you in your daily lives? Something as simple as a hug, unfortunately, is fraught with fear. Linsey Marr, an aerosol scientist at Virginia Tech and one of the world’s leading experts on airborne disease transmission, discusses the risk of viral exposure during a hug in “How to Hug During a Pandemic.” 

Specific COVID-19 Updates and Guidance

The guidance remains the same for people living with myeloma: avoid getting infected. Physical distancing, masks and careful hand washing are vital for your own protection.

• COVID-19 status report and vaccines: “Six Months of Coronavirus” is a very helpful summary of where we are in terms of diagnosis, treatments and vaccine development. The U.S. has now established priorities in the public-private partnerships in the development of vaccines. Five companies have been selected as the most promising to provide the best vaccine candidates. Other companies with great vaccine experience are also working at top speed, so it is difficult to know how the use of vaccines will be implemented on a global basis.
• COVID-19 and patients with myeloma: Data published in The Lancet late last week emphasized the increased risks associated with a cancer diagnosis, which carried a 13% mortality rate overall. This is quite sobering for myeloma patients and deserves some commentary. 

First, it is important to note that new data coming out of the U.K. also indicate potential serious problems for infected myeloma patients. Seventy-five myeloma patients tested positive for COVID-19. The mortality rate was 54.6% (41 patients) for the COVID-19-positive myeloma patients. It is essential to note that poor outcomes were strongly linked to: 

• Age greater than 65 (and especially over 75 years). The median age of those who died was 78 years. The mortality for those over the age of 80 years was 71%. 
• Co-existing medical conditions. So-called co-morbidities were closely linked to poorer outcomes. Hypertension was the most common co-morbidity linked to mortality, occurring in 41.3% of patients. Other factors, such as obesity, diabetes and chronic underlying kidney or lung conditions were also noted. Of current importance here in the U.S., there was increased mortality in those of Afro-Caribbean descent.
• Status of myeloma. In addition to the co-morbidities, the status of the myeloma was also at a delicate phase of treatment for the most severely affected patients. 

How does this information square with the much, much lower infection rates and much better outcomes in many parts of the U.S., Asia and some European countries? 

• Protections in the community: In the U.K. there was an enormous surge of COVID-19 infections with what was an extensive unknown community spread. Myeloma patients were infected in the community over several weeks at that time.
• Overwhelmed hospitals: Tragically, myeloma patients entered the hospitals with delayed diagnoses of COVID-19, encountering an overwhelmed system. 

The Bottom Line

• Myeloma patients must be extremely alert to local community spread and avoid exposure. STAY AT HOME UNTIL SAFE.
• Be especially cautious if the local hospitals are becoming overwhelmed with cases of COVID-19 infections. This is the most dangerous time.
• Be an advocate in your community to stay safe, despite the many daily challenges.
• Patients over 65 (and especially over 75), and those with underlying health issues, as noted above, are at an elevated risk.

Good News About MGUS

A new report from New York summarizes data and outcomes for seven MGUS (monoclonal gammopathy of undetermined significance) patients who became COVID-19 positive. Although one 92-year-old man in a nursing home had serious consequences, the other six recovered.

The authors say that although there are legitimate concerns about impaired immunity in MGUS patients, this small case series suggests that MGUS does not pose additional risk for poorer outcomes in COVID-19 infection.

Good News from Around the World

Despite the enormous difficulties in the U.S. currently, it is truly heartwarming and very important for our sanity to see that it is indeed possible to beat the coronavirus (“How Iceland Beat the Coronavirus” in The New Yorker) without specific treatments nor a vaccine yet available. Prudent public health measures prevailed in this small nation to contain COVID-19. The key is to bring everyone together to both understand the problems and work to implement the testing, tracing and voluntary isolations. Thereafter, normal life activities can return except for mass gatherings (strictly limited). 

A new article on super-spreading events at mass gatherings drives home the point about the extreme dangers of such gatherings. As noted by health experts there is a deep anxiety about the impacts of recent protest gatherings and potential surges to follow. The good news is that we now understand the danger of large gatherings. Now we know to both avoid such gatherings personally as well as interrogate any contacts or friends if they have participated in such events.  As for myeloma overall, knowledge is power, and in this case, it is the power to stay safer.

As mentioned last week, New Zealand continues on its path to reopening its economy in a safe and controlled fashion with full collaboration of all involved. Common sense and kindness prevail. 

The Search for Silver Linings

As we endure what are the most difficult times in recent memory, it is a challenge to stay positive each day. As I look out the window, I continue to see spring and early summer in full bloom, enjoying a break from pollution. There are positive examples of how to stay safe and move forward to reopen our communities. For myeloma patients, personal safety is number one. If possible, it can be nourishing to help others, whether it be a neighbor, a friend or your  community. Be sure to take time to relax and enhance your resilience every day. 

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