Blog series #12: Multiple burdens: rheumatic diseases during a pandemic

Dr. Martin Schäfer is a postdoc at DRFZ – German Rheumatism Research Center and works in the field of epidemiology. In the twelfth part of our blog interview series, he describes factors associated with severe COVID courses specifically for patients who have rheumatic diseases.

Name / Institute:
Dr. Martin Schäfer
DRFZ – German Rheumatism Research Center, Berlin
Leibniz Section C

Research topic:
Epidemiology of the rheumatic diseases

Main featured instrument or technique (for COVID research):
Statistical analysis of data from questionnaire based observational studies

“I investigate factors associated with severe COVID courses, including medications, to help doctors know what patients may need extra protection or advice.”

Dr. Martin Schäfer, why did you decide to stay in academia after your PhD?

I have always liked to analyse and understand things and am generally passionate about science, so to stay in academia was kind of natural for me. At DRFZ, my research can make a difference for patients quite directly, which for me is very exciting and rewarding!

What was your main research topic in the last 1-2 years before spring 2020?

Over the last few years, I have been analysing observational data to determine which medications are most appropriate for different subgroups of patients who have rheumatoid arthritis, as defined e.g. by their age, sex, weight or certain comorbidities. With “most appropriate”, I mean most effective and reducing the risk of side effects as much as possible. Such results are helpful for doctors particularly when they ask themselves how to treat patient groups which are usually not investigated in clinical trials, such as older patients or patients with comorbidities.

What are the main findings of your work on COVID; and did the results surprise you?

Among people with rheumatic diseases, the odds for dying of COVID are higher among men, older people or persons with specific comorbidities such as heart or lung disease. Such factors were already known from the general population and therefore confirmed my expectations. Furthermore, some factors specific for patients with rheumatic diseases are also associated with higher odds of COVID-related death: an elevated activity of their rheumatic disease and a few specific immunosuppressive medications, such as anti-CD20 monoclonal antibody B cell depleting therapies, which are also given to some cancer patients.

In addition to disease-related risks, is it possible to estimate how the medical care of rheumatic patients has been affected by the COVID pandemic?

This may vary between regions and countries. Generally, surveys have found that particularly during the first COVID-19 wave, most personal doctor visits were cancelled and patients primarily communicated with their rheumatologist remotely (limiting the ability to do, e.g., lab tests). A portion of patients even could not communicate with their rheumatologist at all during that time.
So, diagnostic delay temporarily may have affected many patients. Overall, most patients seemed to continue their antirheumatic medications, which afterwards became the recommendation. Still, in the German RABBIT study at DRFZ, we saw that at first patients and doctors were unsure about the potential risks of immunosuppressive medications regarding COVID, and medications were discontinued more frequently, increasing the risk of disease flare-ups. So, when later we came up with results from worldwide data on COVID implying that continuing the immunosuppressive medication was in most cases safe and important, it was reassuring for patients and doctors.

How has COVID affected your life?

I have worked from home office during large parts of the pandemic, but had rarely done this before. So the pandemic at first meant some adaptation for me, involving a somewhat greater need to structure daily work life. Also, I think that doing some physical activity outside every day is important.

Working at home can be very efficient, but it also implied to communicate with colleagues mostly by phone or in Zoom meetings, and after some time I started to miss the casual communication in front of the coffee machine or at lunch. At the same time, exciting new cooperations particularly regarding COVID research emerged during this time which I have enjoyed very much.

You have managed to hook your research into the incalculable emerging pandemic. What is your advice for postdocs that want to embrace such a challenging research topic?

Such a fast-evolving and competitive new research topic requires urgency and dedication while your existing projects remain. So I think that time management is even more important than usual.

What would be the one take-home message of your research?

For people who have a chronic condition like a rheumatic disease, adequate control of their chronic disease remains crucial during the pandemic, even when this involves therapies suppressing their immune system. With a few important exceptions, such therapies generally do not significantly increase the likelihood for a severe COVID course in patients with rheumatic diseases.

How does your perfect day off work look like?

A hike in the mountains (or hills) with good weather and nice people. Mountain scenery is so diverse, both stimulating and mind-relaxing. For me, it’s the perfect counterpart to office work!

We would like to express our sincere thanks to Dr. Martin Schäfer for supporting our new blog interview format with active participation.

Find out more about Dr. Martin Schäfer and his work:

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