The Personal Side of COVID-19: A Q&A with Elna Schiopu, MD

Elna Schiopu, MD, is a rheumatologist who has been in practice for nearly 15 years. She is affiliated with University of Michigan Hospitals & Health Center and an associate professor of internal medicine/rheumatology at the University of Michigan Medical School, Ann Arbor, Mich.

Dr. Schiopu has experienced the COVID-19 pandemic response from both clinical and research perspectives. She recently discussed her experiences with The Rheumatologist (TR).

Dr. Schiopu

TR: What lessons have you learned from the pandemic?
Dr. Schiopu: The question is complex, and this situation is unprecedented. There are several layers around COVID-19 knowledge, starting with the naked data surrounding what happened, such as structure of the virus, its transmission, its mortality, etc. The next layer is the different perspectives [on] interpreting the data—epidemiologist, infectious disease experts, etc. The following layer is the media and the spinning by both traditional and online media in their presentation of the facts. The last—and probably biggest layer—is how do we interpret [the data], and how we adjust to what is happening from a family, physician, immunology perspective.

TR: How did your practice change to meet the demands of the pandemic?
Dr. Schiopu: My feeling was incredible frustration. It’s like when patients bring me a bottle with a supplement, hand it to me and ask if it is safe. The problem is we have very minimal data on what is in it—let alone its safety.

I [have] felt the same through most of the pandemic. Patients are told to ask your doctor, but what do we know? Having no data is almost better than so much contradictory data. As a physician with patients who have family and friends calling us and asking what to do, it was frustrating to say the least.

New patient access became complex because everything was shut down. When patients were sick, there was no hesitation. We were able to convey to our patients the need for them to start immunosuppressive drugs and not wait for the pandemic to end.

What hindered me—and I am beyond furious—was state government interference in our medical practice. There was a time when the governor of Michigan—who does not hold a medical license—banned doctors from prescribing hydroxychloroquine for COVID-19. This [decision] created a lot of hoops for prescribing this medication to non-COVID patients.

In addition, the lengthy, statewide strict lockdowns spread fear and distrust among our patients without seemingly helping in any way with transmission of the virus. At times, I felt advocating for our patients could result in professional backlash, because we still had (have) to keep up the narrative that this virus kills everyone in its path—which we are learning is far from being true.

TR: What are your thoughts on telemedicine?
Dr. Schiopu: Telemedicine is a necessary evil. Early on, telemedicine was the only way to stay in touch with patients without unnecessary exposures.

Personally, I am currently 100% face to face now. As a rheumatologist, we need to feel joints and listen to the lungs. There is so much we do that is missing with telemedicine. Personally, I think it is just not adequate care.

Telemedicine is a great tool for stable patients when we are discussing treatment and how it’s going. As far as coming to clinics and examining joints, seeing the patient and getting the family’s input, that is not happening through telemedicine. My observation is that patients are less likely to be compliant with their drugs after telemedicine.

TR: Have you had any concerns about immunosuppressive medicines?
Dr. Schiopu: From my perspective, there was zero hesitancy prescribing immunosuppressive drugs. I thought it was mandatory to hunker down and stay the course, so [advised] patients [to continue] their regimen.

TR: How did COVID-19 impact your research?
Dr. Schiopu: All 10 of my trials went on because they were interventional. Many research efforts qualifying as observational were halted. An immense body of science and research funds were—and still are being—wasted.

I am very proud of my team and my patients—they all came through. We had about four weeks when we scrambled to send out the trial medications to patient’s homes. I am writing a paper now about our response and how none of our research patients got COVID-19. They masked, kept their distance, washed their hands and were just fine.

TR: How was reopening?
Dr. Schiopu: Reopening occurred slightly over summer time. In the university clinics, we are limited to four people, including staff and doctors, in the charting area—all wearing masks with visors. My hope is we will slowly allow more physicians in clinic, which is associated with more patients.

Before COVID-19, we were already cramped for space, and COVID-19 has made it worse. I had to fight to bring in a medical student. Because of the number of people allowed, someone had to leave.

We need to look at transmission in clinics. If we are seeing none, we need to ask ourselves if we can open up a little bit more.

TR: What are you telling your patients about a COVID-19 vaccine?
Dr. Schiopu: I start by making sure they are up to date with their common vaccines. If they ask me what I think about the COVID-19 vaccine, I first clarify their understanding and impressions. I talk to them about the process of vaccine approval and the need for complex, lengthy trials that include large numbers of people. I explain the timeline, so they understand this vaccine isn’t something developed overnight.

I don’t either support or reject [it] at this time. I emphasize that we need more data, which doesn’t happen in a month or two.

TR: Any pearls or other points of interest you found during the pandemic?
Dr. Schiopu: We are in unprecedented times. We need access to data, not fears or opinion. I don’t want another person’s opinion to influence me. I need the data to form my own opinion. Everyone expects physicians to be able to advise and care for our patients, but we need quality data.

Rheumatologists have a crucial role caring for older, immunosuppressed, vulnerable populations. The biggest challenge is looking at things in a very balanced way. I disagree that the only solution is home isolation awaiting a vaccine. This [approach] causes a great deal of immobility, depression, flares and chronic pain.

The New York Times published a piece in 2016 stating social isolation is the leading silent killer in the U.S. It’s currently broadly used, without any evidence of prior success, as the only pandemic tool. Has it worked? Seven or eight months in, we should have a lot more data about the fallout of all of [the social isolation and the pandemic]. Any decision we make going forward has to be based on the cost and effectiveness data balance. Did we achieve enough to justify the cost?

Kurt Ullman is a freelance writer based in Indiana.