As providers, we have drastically seen how the realm of public health has influenced our professional lives – whether we serve in academia, in administration, in research, in private practice, or within the hospital setting. COVID has become synonymous with the term public health recently and it has dominated our dialogue over the last year and a half – and rightly so. But we all know there are other issues that deserve attention too.

You best know the ACOI for providing a variety of quality CME for physicians, both online and in person, and in addition to providing internal medicine CME, the ACOI has been working diligently to keep you up to date by sharing updates on the ongoing COVID-19 saga as well as expanding our coverage to include other public health concerns as well. Coming up next month is the ACOI Annual Convention & Scientific Sessions. Make sure to join us in person in Orlando October 27-30. If you can’t make it in person, please join us virtually. Hope to see you there!

What is Long Covid and What Are The Symptoms?

Long COVID

You’ve no doubt heard the term Long COVID – a nickname of sorts for the condition that many people are discovering are the long-term effects of having been infected with the SARS-CoV-2 virus. Now we’re starting see some evidence that COVID may actually have long-term cardiological implications – something I have long-feared. A study led by a clinical epidemiologist in St. Louis found that heart damage from COVID-19 extends well beyond the disease’s initial stages. It even found that people who were never really all that sick and didn’t require hospitalization risk developing heart failure and/or deadly blood clots a year later. The study found that the chances of a heart attack, a stroke, or another major cardiovascular event in the first 12 months of COVID recovery actually increased with the severity of the initial bout with COVID. This makes sense, but here’s where it gets interesting. When you compare the risk of suffering heart complications with individuals who survived COVID to the risk in their peers who didn’t get COVID, it was discovered that a non-hospitalized COVID patients had a 39% increased risk of developing heart failure and a 2.2-fold increased risk of a pulmonary embolism in the following year, compared to those who never got COVID. Even more interesting is the risk for individuals who have been hospitalized with COVID. There is actually a 5.8-fold increased risk of cardiac arrest and almost a 14-fold greater chance of myocarditis for those who had serious enough COVID symptoms that they landed in the hospital. For those who were in ICU when they suffered from COVID, almost one in seven suffered a major adverse cardiac event within a year that they likely would not have had without having suffered from COVID.

So the big question always is "why?" That’s still being defined, but it is possible that the causes of heart damage could be due to the lasting damage from the direct viral invasion of heart-muscle cells and/or the cells that line the blood vessels due to the persistent inflammation that lingers. Also the complications of the social isolation, dire financial consequences, and the trauma associated from the pandemic are also thought to have influenced cardiovascular risks. Another long COVID concern is very new research suggesting that COVID-19 could actually trigger diabetes. Some COVID-19 patients having developed symptoms of diabetes after infection making scientists wonder if COVID-19 could in fact be the culprit. There is much more to be uncovered on this, but some early findings are suggesting that the coronavirus could be prompting the pancreas to self-destruct. As the pandemic progressed, there was a growing number of reports people who caught COVID-19 were noticing diabetes symptoms for the first time. There’s an interesting theory out there that is suggesting that the body could be confusing pancreas cells for the coronavirus and trying to destroy them, disrupting the insulin supply. There is so much more to learn on this and if you are attending the ACOI Convention & Scientific Sessions in a few weeks, you’ll learn more about the varying risks posed by long COVID – because that’s in my session!
 

Drug Price Increases - A Public Health Threat

One of the most frustrating things in public health from my perspective is seeing treatments formulated and miraculous prescription drugs approved and made available to help manage and treat dangerous diseases and chronic conditions while a large portion of Americans face a growing inability to be able to actually afford the prescription drugs they need. The epidemic of rising drug prices isn’t new and I’m convinced that the exorbitant costs charged by big pharma have vastly contributed to so many Americans not being able to get the care they need.

A story came out about a few days ago about Merck that just proves the point even further. Recently, Merck planed to request emergency federal authorization for molnupiravir. A late-stage clinical trial revealed that a five-day course of the antiviral drug cut the risk of COVID-19 hospitalization or death in half in patients with mild-to-moderate cases. That’s the kind of innovation we need to take down this pandemic. But the same day that Merck unveiled the results of the trial and there was collective excitement that molnupiravir could be an effective tool against COVID-19, it was reported that the federal government is going to be charged a price of $700 per patient to buy the drug. And when I say the federal government is buying the drug, that means our tax dollars are being used, which means the American people are buying the drug – at a highly inflated price. The drug costs $17.74 to produce. It's easy to understand why Merck is being accused of price gouging.

The same is true with other drugs. Just compare the costs of what insulin costs Canadians - $12 per vial to the average price of $98.70 per vial being charged in the United States. So while we have an epidemic of chronic disease, it is being said that the epidemic of greed in the pharmaceutical industry is the bigger problem.
 

Malaria Vaccine Update - Good News

Let’s wrap with some really good news - the recent announcement of the development of a malaria vaccine! For those of us who have been to Africa or Asia, or any place where there is malaria, and for those of us who have gotten malaria, this is truly a miraculous development. The world’s first malaria vaccine is also the world’s first anti-parasitic vaccine which was endorsed last week by the World Health Organization. This will have big implications on how countries that are affected by malaria can hope to manage the disease. On Africa, a continent with about 1.3 billion people, malaria accounts for nearly ½ million deaths each year. Thanks to the success of clinical trials carried out in Ghana, Kenya, and Malawi, there is now hope against this horrible disease. Since 2019 more than 800,000 children have received the vaccine as part of the trials. That same year, there were an estimated 215 million cases of malaria throughout the world. Thanks to the promise of this new vaccine, I can look forward to the day when that number is zero.

Sources:

• Heart Damage Plagues Covid Survivors a Year After Infection, Study Shows (msn.com) 
• SARS-CoV-2 infection induces beta cell transdifferentiation - ScienceDirect 
• People are developing diabetes after COVID-19. It might be because the virus messing with insulin-producing cells, new research suggests. (msn.com)  
• 'Entirely Unsurprising': Merck Slammed for 4,000% Markup of Taxpayer-Funded Covid Drug (commondreams.org) 
• Africa welcomes new malaria vaccine as a 'game-changer' (msn.com) 
• World Malaria Report 2020 (who.int)