Crisis leadership: a case for inclusion in accredited Master of Public Health program curricula.

OBJECTIVES: To evaluate the exposure to crisis leadership theory already present in Council on Education for Public Health (CEPH) accredited Master of Public Health (MPH) programs in the United States and provide a compelling case for its future inclusion. STUDY DESIGN: This was a narrative review. METHODS: We compiled a comprehensive list of 179 CEPH schools that offered an MPH program. During January through March 2021, we examined 179 websites for the core courses and elective courses offered in the MPH degree program to determine if any courses covered the topics of leadership, crisis leadership, or crisis management in either the course title or description. RESULTS: Leadership courses were available in only 55.31% of CEPH-accredited schools. Only a single program (0.56%) offers a crisis leadership course. CONCLUSIONS: The current global COVID-19 pandemic and reality of climate-induced disasters have brought crises to the forefront for health systems. Successful leadership for the future requires public health leaders to have training in crisis leadership. The evaluation and revision of public health curricula must focus on leadership competency development to prepare graduates to lead complex multiple crisis events and system shocks simultaneously.

COVID-19 INFECTION IN PATIENTS WITH HEMATOLOGIC DISORDERS IN THE REPUBLIC OF ARMENIA: FOUR CASES STUDIES FROM THE NORK NATIONAL CENTER OF INFECTIOUS DISEASES

The COVID-19 pandemic presents unique challenges for immunocompromised patients. These patients include those with hematological malignancy such as acute and chronic leukemias, lymphomas, myelodysplastic syndromes, and multiple myeloma. Patients with malignancy disproportionately suffer from severe complications and fatality from COVID-19. These patients are at high risk of developing secondary bacterial and/or fungal infections. Theoretically if treated with steroids during the first week of COVID-19 disease, worse clinical outcomes might be expected in immunocompromised patients. If so, the start of aggressive steroid treatment in the early stages of COVID-19 can prolong the course of disease and cause complications thus increasing the mortality rate. We conducted a prospective observational study in all patients with COVID-19 diagnosis from the Nork National Center of Infectious Disease hospital between August 1st and November 30th, 2020. Four unique cases of SARS CoV-2 infection with hematological malignancies are described. Based on analysis of the clinical course in these four patients we conclude that steroid therapy should not be casually administered in late stages of COVID-19. The choice of steroid, including dosage, duration, the initiation time and supportive therapy should be determined individually for each patient taking into account the course of the disease and the treatment received up to that point. In patients with immunosuppressed status, the risk of developing serious secondary infection is high. Receiving chemotherapy within the previous six months can significantly impact disease severity and outcomes. Further expanded investigations are needed to assess multiple factors impacting outcomes for patients with malignancy.

Blood il-6 levels as a predictor of the clinical course severity in covid-19 infection: Data from the Republic of Armenia

Patients with severe cases of COVID-19 infection can develop acute respiratory distress syn-drome, septic shock, multiple system organ failure, bleeding, and coagulation dysfunction. Severe forms of COVID-19 are characterized by viral pneumonia patterns and are frequently associated with elevated serum levels of pro-inflammatory cytokines forming a “cytokine storm”. Among the mediators of cytokines release syndrome, interleukin-6 is one of the key cytokines. Tocilizumab, a monoclonal antibody against interleukin-6 receptor, may provide clinical benefit for selected COVID-19 patients with high inflammatory biomarkers. In this prospective study, we aimed to correlate the blood levels of interleukin 6, C-reactive protein, procalcitonin and other biomarkers to the clinical course and outcome of COVID-19 patients in our study cohort. Our study shows that several biomarkers and in particular serum interleukin-6 levels dif-fer according to disease severity in COVID-19 infection. Serum interleukin-6 levels were also significantly increased in non-survivors and could raise the potential benefit of tocilizumab for selected cases of COVID-19 infection. Data about the efficacy of tocilizumab are conflicting. However, our data about tocilizumab may suggest a potential benefit, and is in-line with previous data about the absence of significant risk of super-infection. The early short-term administra-tion of methylprednisolone in a 250-500mg/daily dosage revealed good results with and without concurrent tocilizumab therapy.