June 7, 2020: Public Health Crisis Round-up

Intro and Disclaimer

QM would like to help you make sense of information being circulated by: 1. Translating data into digestible language, 2. Dispelling misconceptions and linking to evidence, and 3. Curating relevant data, and articles on a weekly basis. Our Round Up/ Mythbusting projects are intended to help our QM family make sense of information being circulated. Taking control of our health as a queer community includes making institutional knowledge accessible to the public. 

Disclaimer: Although this information has been evaluated and determined to be accurate by Queering Medicine (QM), we at QM do not want to give the impression that we are the sole gatekeepers of medical knowledge. As a collective, QM members bring professional and personal qualifications that allow us to research and share credible knowledge. Our goals for this weekly round up and myth busting is to translate data into digestible information, dispel misinformation, and curate relevant data for the Lansing queer community. We encourage the community to question knowledge found outside of reputable sources, however, Queering Medicine will gladly help facilitate this process. If evidence or recommendations change, or any inaccuracies are found, we will correct them and explain the changes. If you have any questions about our methodology and sources, or you would like to point out any inaccuracies, please let us know!

Racism is a Public Health Crisis 

“Racism is a system of structuring opportunity and assigning value based on the social interpretation of how one looks (which is what we call "race"), that unfairly disadvantages some individuals and communities, unfairly advantages other individuals and communities, and saps the strength of the whole society through the waste of human resources." — American Public Health Association Past-President Camara Phyllis Jones, MD, MPH, PhD”

In light of George Floyd’s murder by the Minneapolis Police Department, there have been protests across the United States and across the world. While protesting seems contradictory to public health urges for social distancing to reduce the spread of coronavirus, public health officials have been in support of the protests. Police brutality is an expression of racism and impacts the health of communities, specifically Black and Brown communities. This week, a group of infectious disease specialists from the University of Washington drafted an open letter supporting protests against structural racism and a call to action for public health - which was signed by an additional 1,288 public health and medical officials. Across the country, public health officials have been declaring racism a public health crisis. In our own area, the Ingham County Health Department pledged to declare racism as a public health crisis earlier this week. While declaring racism as a public health crisis is crucial to start the conversation and would allow restructuring of some budgets to address health inequities, supporting social justice is a foundation of public health practice. The point of public health is to protect and improve the health of all communities and individuals. To do this, public health must engage in dismantling of systemic oppression through anti-racist policies, programs, and procedures. Systemic racism directly impacts the health of Black individuals in this country. Racism has been an ongoing pandemic since the beginning of this country and it is insidious. The dismantling of structural racism will take persistent and strategic work by public health. It will take listening, valuing, and prioritizing Black individuals to achieve health equity. It is the responsibility of public health professionals to engage in this work because racism is a public health crisis. We cannot remain silent. 

Links:

• https://www.apha.org/topics-and-issues/health-equity/racism-and-health

• https://slate.com/technology/2020/06/protests-coronavirus-pandemic-public-health-racism.html

• https://drive.google.com/file/d/1Jyfn4Wd2i6bRi12ePghMHtX3ys1b7K1A/view

• https://qz.com/1865308/how-to-address-racism-like-the-public-health-crisis-it-is-3/

Reopening Michigan

This week, Governor Whitmer lifted the stay-at-home order and revised many of the restrictions on businesses and gatherings in Michigan. Here are some of the major impacts and dates for the Lansing area (Northern Michigan and the UP are reopening more quickly):

• June 1: Stay-at-home order lifted; groups of up to 100 people can gather outside (with social distancing); office work that can't be done remotely can resume (with restrictions); in-home cleaning services can resume; outdoor fitness/athletic training and games can resume (if everyone involved can maintain six feet of separation at all times)

• June 4: Retailers can open without appointments (with reduced capacity)

• June 3: Hospitals, doctor's offices, and outpatient clinics can allow visitors (with masks, screening, and other restrictions)

• June 8: Dine-in service at restaurants can resume (at up to 50% capacity), day camps for children and outdoor pools can reopen (with reduced capacity), libraries and museums can reopen (with reduced capacity)

• June 15: Hair stylists, nail salons, tattoo shops, and massage shops can reopen (with masks, etc.)

All of these changes come with the caveat that people must follow social distancing guidelines (maintaining six feet of distance from people not in their household, wearing a mask, etc.) to the extent possible, and most include significant restrictions on capacity. That means that while you may get closer than six feet at a hair stylist, you can't get closer than six feet at a social gathering.

This does not mean that the pandemic is over or that the risk of COVID-19 has been eliminated: There have been over 200 deaths from COVID-19 in Michigan in the last week alone. It is critical that social distancing rules are still followed, or we will likely have another wave of infections and will need to go back into lockdown. Wear a mask when you expect to be near others (even outdoors), keep at least six feet away from people outside your household to the extent possible (sorry, no handshakes or hugs yet!), avoid touching your face, and wash your hands frequently. Also remember that individuals who are at high risk from COVID-19 are safer not going out, and should not be pressured to change their behavior yet. We understand that people are ready to get out, see friends, go shopping, and eat in restaurants again, but we urge that you remember your safety and the safety of others when you do so.

More Information

• "Michigan Gov. Whitmer lifts stay-at-home order across state, reopening restaurants, more" https://www.clickondetroit.com/news/local/2020/06/01/michigan-gov-whitmer-lifts-stay-at-home-order-across-state-reopening-restaurants-more/ 

• "Michigan stay home order lifted: What you can and can't do" https://www.freep.com/story/news/local/michigan/detroit/2020/06/02/michigans-stay-home-order-lifted-frequently-asked-questions/5282418002/ 

• "Michigan workplaces can reopen after stay-home order. Here's what you need to know" https://www.freep.com/story/news/local/michigan/2020/06/01/michigan-offices-can-reopen-after-stay-home-order-coronavirus/5212236002/ 

• "Hair, nail, massage businesses to reopen across Michigan on June 15, Gov. Whitmer says" https://www.clickondetroit.com/news/local/2020/06/05/hair-nail-massage-businesses-to-reopen-across-michigan-on-june-15-gov-whitmer-says/ 

• "New Michigan order eases restrictions on hospital visitors" https://www.detroitnews.com/story/news/local/michigan/2020/06/03/new-michigan-order-eases-restrictions-hospital-visitors/3135137001/ 

Vaccine Progress

Claim: A vaccine will come by the end of this year

Verdict: Likely false

According to Lancet, there are currently 10 candidates in clinical trials for a vaccine for COVID-19, and more than 100 candidates in pre-clinical trial development according to the World Health Organization. On average, vaccines take about 10 years to produce after approval from the four typical stages of development, and the success rate for overall development is about 6%. Even with vaccines being fast-tracked, they are still likely to take months or years to develop and become available, and reducing research and trial duration brings additional risks, including side effects not being determined until after the vaccine is in wide use. AstraZeneca’s vaccine is the first to make it to phase 3 studies, with a 10,000-person trial in the UK and a 30,000-person trial slated for this summer in the US. Even as White House officials have stated that there are “2 million vaccines ready to go,” most sources don’t expect a vaccine until next year. 

Outside of proving the science of developing the trials, there are several factors that could accelerate or decelerate trials. One factor is the agreement of the attack rate of COVID-19 (rate of new infection in a population), which might vary from one state, city, or country to the next. The other is how the trials are conducted. For example, there is discussion of “live trials” occurring that could speed up trials, where participants receive a vaccine and then also are exposed to the live virus. Lastly, the rollout of vaccines and designation of who gets the vaccine first could logistically impact when someone receives a vaccine.

Helpful Links:

• “Trump Says U.S. Is ‘Ready To Go’ With 2 Million Coronavirus Vaccines Upon Approval”

  • https://www.forbes.com/sites/carlieporterfield/2020/06/05/trump-says-us-is-ready-to-go-with-2-million-coronavirus-vaccines-upon-approval/

• COVID-19 vaccine protects monkeys from new coronavirus, Chinese biotech reports” 

  • https://www.sciencemag.org/news/2020/04/covid-19-vaccine-protects-monkeys-new-coronavirus-chinese-biotech-reports 

• “Chinese military scientists record promising results from coronavirus vaccine trial”

  • https://www.scmp.com/news/china/science/article/3085796/chinese-military-scientists-record-promising-results-coronavirus 

• Moderna Vaccine Trial update: 4/45 experienced Grade 3 AE’s 

  • https://www.statnews.com/2020/05/26/moderna-vaccine-candidate-trial-participant-severe-reaction/

  • https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31252-6/fulltext

  • https://www.cnbc.com/2020/06/05/trump-says-us-has-2-million-coronavirus-vaccine-does-ready-to-go.html

Is COVID-19 a Vascular Disease?

A recent article was published outlining a current hypothesis regarding COVID-19: What was initially thought to primarily be a lung-related disease may actually be a disease of blood vessels.

One study showed that changes in blood vessels helped differentiate COVID-19 from other severe viral infections. Another recent publication by the American Heart Association stated that up to 40% of COVID-19-related deaths have involved cardiovascular complications, such as blood clots or blood vessel damage. This suggests that if this current hypothesis proves to be true, different categories of existing medications may be beneficial to those with COVID-19.

On the flip side of this topic, a recent study looking at cardiovascular disease therapies for treatment of COVID-19 suggested that common high blood pressure medications may be effective in treatment. That study, however, was recently retracted, citing lack of data verification. 

What this means for the public:

• Whether COVID-19 is a vascular disease has yet to be determined, but there are studies that show looking at specific blood vessel issues can differentiate COVID-19 from other, similar diseases.

• A major publication that may have corroborated this theory has been retracted.

• There are issues with rushing research to be published before all data can be verified.

• There has been prior research to suggest COVID-19 may be a vascular disease, but more research is needed to confirm this so that other routes to COVID-19 therapies may be pursued.

Helpful Links:

• Original Article Stating COVID-19 may be a Blood Vessel Disease
  https://elemental.medium.com/coronavirus-may-be-a-blood-vessel-disease-which-explains-everything-2c4032481ab2

• American Heart Association Publication on COVID-19 and the Heart
  https://www.ahajournals.org/doi/pdf/10.1161/CIRCRESAHA.120.317055

• Study on Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19
  https://www.nejm.org/doi/full/10.1056/NEJMoa2015432

• Retracted study on Cardiovascular Disease, Drug therapy, and Mortality in COVID-19
  https://www.nejm.org/doi/full/10.1056/NEJMoa2007621

• Retraction Statement:
  https://www.nejm.org/doi/full/10.1056/NEJMc2021225?query=featured_home

Hydroxychloroquine Update

A recent study that was widely cited with regards to safety concerns of hydroxychloroquine has been retracted by the Lancet due to lack of data verification. Although the WHO and other organizations have resumed clinical trials regarding hydroxychloroquine, there is still no evidence that use of hydroxychloroquine is effective in treating COVID-19.

Another study recently published showed that hydroxychloroquine did not help to prevent those exposed to others with COVID-19 from getting the disease. Thus, there is still no evidence that hydroxychloroquine is effective in treating or preventing COVID-19.

What this means for the public: 

• Retracted studies happen.

• Unfortunately, when there is a huge push for a lot of research in a short amount of time, studies with issues may be published without being fully verified and reviewed, further reinforcing the idea that research should not be rushed if possible.

• At this point, there is still no evidence that hydroxychloroquine is effective in treating or preventing COVID-19 after exposure to the virus.

• Research is still being done on this topic and we will update as more information becomes available.

Helpful Links:

• Retracted study:
  https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31324-6/fulltext

• Hydroxychloroquine does not help prevent development of COVID-19 after exposure to the virus:
  https://www.statnews.com/2020/06/03/hydroxychloroquine-does-not-prevent-covid-19-infection-in-people-who-have-been-exposed-study-says/

• Study for post exposure prophylaxis of COVID-19 and hydroxychloroquine:
  https://www.nejm.org/doi/full/10.1056/NEJMoa2016638?query=featured_home

QM Public Health Crisis Round-Up Team (in no particular order): 

• Mauricio Franco (he/him/his), M.S.- Global Medicine, Third year medical student.

• Andrew-Huy Dang (he/him/his), Third year medical student, B.S. Microbiology.

• Wyatt Shoemaker (he/him/his), Third year medical student.

• Antonio Flores (he/him/his), Second year medical student, B.S. Public Health Sciences.

• Daniel Pfau (they/them/theirs), Neuroscience PhD, Biological Sciences MS, Homeschool Teacher.

• Francis Yang (he/him/his), M.S.-Global Medicine, First year medical student.

• Kryssia Campos (she/her/hers), First year medical student.

• Alessandra Daskalakis (she/her/hers): First year medical student, B.S. Biology, B.A. Comparative Literature

• Vanessa Burnett (she/her/hers) M.P.H; Health Equity Consultant, Michigan Public Health Institute

• Wilfredo Flores (he/him/his), M.A. Technical Communication

• Grey L. Pierce (they/them); M.A., Cognitive Psychology; Assistant Director, Michigan State University (MSU) Usability/Accessibility Research and Consulting; Project Manager, State of the State Survey, MSU Institute for Public Policy and Social Research