COVID19: Managing Autoimmune, Psychiatric and Trauma ResponsesMarch 31, 2020

Joel Lamoure, RPh, DD, FASCPTelepharmacist, The Northwest Company

Canadian Section Chief, Medical Bioethics, UNESCO

Email: jlamoure@northwest.ca Twitter: @JoelLamoure

LifetimeDisclosures

Research Funding: Eli Lilly Canada, Sanofi Canada

Advisory Boards: Janssen-Ortho, Pfizer Canada, BMS Canada, Lundbeck Canada, Pfizer Global, Sunovion Canada

Speaking Honoraria: Eli Lilly, Janssen-Ortho, Pfizer, Astra-Zeneca, Shire, LundbeckCanada, Valeant Canada, Otsuka Canada, Sunovion Canada, Pediapharm Canada, Medexus Canada

International Congress Funding: Pfizer Canada, Lundbeck Canada

Medical Writing Consultant: Medscape, Canadian Journal of CME (STA Communications), Canadian Healthcare Network (Rogers Healthcare)

Other Related Financial: Online shopping platform store

To cite this presentation (APA Citation): Lamoure J., COVID19: Managing Autoimmune, Psychiatric and Trauma Responses. (Webinar) Canadian Society of Hospital Pharmacists. Ottawa, Canada March 31, 2020

Disclaimer: Note that all slides in this presentation are copyright by the authour and the opinions contained are those of the presenter. Contact by email at jlamoure@northwest.ca for any queries. This presentation is not designed to be a substitute for medical care or advice. If you have urgent clinical symptoms, please contact 911 or consult a health professional immediately.

Learning Objectives

Provide an overview of COVID-19 medical psychiatry and autoimmune cascades in a pandemic situation

Review and apply pharmaceutical learnings from previous pandemics to nCov-SARS-2 2019

Discuss impacts of non-prescription and alternative interventions used by the population

Empower clinicians and patients’ safety and HOPE/resiliency through an overview of trauma-informed care

Touch on RNA and intergenerational trauma and mitigation of trauma risk factors in a crisis

Initial Thoughts

How do we grieve for a culture and societal connections that have been abruptly taken away from us?

Introversion vs extroversion

FMEA and desire to lay blame in the face of powerlessness

Humanity means that we have the wherewithal to engage in intelligent concern for each other

Its not about age, race, sex, gender or religion

Its about responding to the threat by an unknown assailant with unconditional embracing of our equality

A lot of very complex theories are being condensed and pulled together into short, bite sized encapsulations. The interpretations are mine and each of these topics blow out into their own literature and theories. In my defense, this is a 2 year course being condensed into 20 minutes…

Ident-A-Kit. The Perp: COVID-19

Observed and reported up on unusual signalling in Oceania Summer 2019 in WHO data with potentially zoonotic etiology

Clinical Observations (not present in all and not inclusive) Increased SCr/ BUN

ARF

Fever

Hypotension

Marked left shift ( greater than 90% neutrophils: WBC)

Fatigue and malaise

Opacities on CXR.

Co-existing autoimmune cascade that coexists (psychiatry, RA, transplant, DM, autonomic, dyslipidemia, asthma). I include psychiatry in here as there is a good body of evidence regarding interleukins, cytokines and psychiatry.

Potential- later stages present with a type of MSOF, RBC dyscrasias

Dengue fever and COVID-19 and geopolitical/geographic exposure and clinical experience observations

What is Medical Psychiatry?

The interface between all things psyche and all things physical and how one impacts on the other

This works two ways, both positive and negative

Lessons Learned: Autoimmune

Spanish Influenza 1918-1920

nCov-SARS-1 2003

H1N1 2009-2010

What populations may be at risk?

Cytokine review and interleukins (esp. 6 and 8) Review of systems including psychiatry

Diabetes, RA, ESR/CRP impacts,Neuro (MS etc), Crohns

Weathering and awareness of the upcoming cytokine storm

Neurological vs cardiac perspectives and observations 2009 to 2020…what is different?

Relationship Status: It’s Complicated

Relationship Status: Managing Loss and Divorce

#1- Understand yourself and relationship with the “Ex” Respect the your thoughts and feelings

What do visitation rights look like?

There is going to be a change in dopamine and serotonin

Past traumas, ADHD, learning disabilities

Drug interaction impacts

Trauma and psychology

Grief and grieving

Acknowledging and accepting the grief

Validation of emotions

Kubler-Ross model cycle of grief and loss

Pavlov, Maslow and Toilet Paper

Its all about the safety No safety means no executive higher processes

We hear the panic bell on the media and do more than just salivate

No higher processes means non-clear thinking

Non-clear thinking means we operate at a root animal emergency level mindset

Means impaired critical thinking

Means we as clinicians and patients may make improper choices

Action and reaction and the impacts of PROJECTION

Products/ Cures/ What stocks Should I Buy ?

Think of the impact of the words and semiotics

There is no cure. This presentation will not go into septic or ventilator management, antimicrobial options, ARDS, VAP, PPI’s, NSAIDs, inotropes etc.

Far more skilled clinicians than I speak to these evidence based guidelines

What are patients trying? Chloroquine, Hydroxychloroquine Including tropical fish grade chloroquine!

Licorice, umckaloabo, periwinkle, DHG, zinc, elderberry, echinacea, capsaicin, garlic, vodka, filtering Scotch through a kilt etc. etc.

What does that mean to clinicians and patients?

Trauma and You, and our next three generations…

Story time about the Great Depression Potential impact on abdominal girth

Its takes 21 days to change a behaviour

RNA memory encoding of the interface impact from the trauma and behaviours

HOPE, Resiliency and Empowerment Holistic, Outcome, Personalized, Empowerment

Mitigating Risk and Staying Sane Its all about you and your desires

Play therapy

Online shopping

Learn a new language

Take a course

Phone-a-friend

The list is endless

Caveats and cautions

Medications and You and Your Patients

Evidence based medicine to make evidence based decisions

Let your prefrontal cortex work, not your amygdala AKA- think smarter, not harder

Don’t be afraid to think outside the box, there is no playbook Don’t be paralyzed from critical decisions if 100% of the information isn’t available Non-maleficence, benevolence, autonomy and justice must guide us

TAIDCC- #COVID19RX must fit each of the pieces in this mnemonic

Trauma history means when dealing with serotonin, dopamine, norepinephrine- start and go EXTRA slow. There will be more activation and adverse effects across body systems

“Home remedies” that pop up on patient BPMH’s will have drug interactions too -> even the licorice root, zinc and the kilt-filtered Scotch

Stressed traumatized people going through grief will almost always not make the most logical, safe choice

We need to be there for them and their families.

It’s complicated and like a bad romance, but look after yourself and pleasepractice good caring and sharing

Final thoughts

“We have one of the most important commodities right now in our health and knowledge. Giving and sharing with those less fortunate or struggling is another way to share that, which is what we call humanity. The best way to manage a crisis is controlling the narrative, planning, then practice literally one minute, one patient, and one case at a time.”

“To do too many risks being overwhelmed. In closing, losing self‐care is to lose your higher‐level thinking, as well as your knowledge and skills for patient advocacy and care that improves patient outcomes. And that would be a loss to all, the most tragic COVID casualty.”

Resources

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Contact Information:

Joel Lamoure, RPh, DD, FASCPTelepharmacist, The Northwest Company

Canadian Section Chief, Medical Bioethics, UNESCO

Email: jlamoure@northwest.ca Twitter: @JoelLamoure

Copyright notice: This presentation will be available through open access by the Canadian Society of Hospital Pharmacists to help inform and fight #COVID19 by permission of the authour. Please contact the authour for permission to reproduce this material in part or full.

To cite this presentation (APA Citation): Lamoure J., COVID19: Managing Autoimmune, Psychiatric and Trauma Responses. (Webinar) Canadian Society of Hospital Pharmacists. Ottawa, Canada March 31, 2020