COVID-19 Perspectives Shared in ACR Convergence Opening Session

ACR CONVERGENCE 2020—Eric Rubin, MD, PhD, took over as editor in chief of the New England Journal of Medicine in September 2019, just a few months before COVID-19 began taking over the world.

Since then, Dr. Rubin’s perspective on the pandemic has been unlike that of any other person: He has led reviews of a deluge of new research on the disease at the nation’s most distinguished medical journal, privy to new data on potential therapies to improve outcomes across the globe. And he has done so with a particular level of expertise: His specialty is infectious disease.

Dr. Rubin

Dr. Rubin shared his thoughts on the pandemic in a keynote address at the opening session of ACR Convergence, a COVID-19-focused session that also included a presidential address from ACR President Ellen Gravallese, MD, on lessons learned from the pandemic.

Convergence of Infectious Disease & Rheumatology
One of his main messages, Dr. Rubin said, was the connection of infectious disease and rheumatology.

“There are real alliances between the two fields,” he said. As a young boy, he had chickenpox and recovered, but a few weeks later developed encephalitis, which, for a time, left him comatose and later unable recognize his parents.

“I clearly had an infection, but I also had an inflammatory disease that was connected to the infection—but was independent,” he said. “Inflammation is an integral part of what can cause damage during infection.” This has been underscored by the COVID-19 epidemic, he said, in which the subsequent inflammatory response has proved devastating for many patients.

Dr. Rubin’s address was given days before the first results for efficacy and safety were announced for two COVID-19 vaccines, which the manufacturers have said are about 95% effective.

But attention to safety should remain a top priority, his comments suggest.

“I can’t overemphasize how much safety plays a role in the decision of whether or not to go forward with a vaccine,” he said. “Yes, COVID-19’s a bad disease, but this vaccine is likely going to be given to an enormous number of people—maybe billions of people.”

Rare complications from the rotavirus vaccine, for example, weren’t seen until the vaccine was given to hundreds of thousands of people. “The longer we wait, the more likely we are to catch late events,” Dr. Rubin said.

As for treatment, public health measures aimed at prevention—mask wearing, social distancing and testing followed by contact tracing—have been shown to work. Treatments have had some success—remdesivir to prevent viral replication has had “a rather minor effect,” and dexamethasone’s effects to control inflammation in critically ill patients have been small but dramatic, helping reduce the number of deaths, he said.