Episode #84: Dr. Alexandra Freeman
Dr. Alexandra Freeman is a pediatric infectious diseases physician at the National Institute of Allergy and Infectious Diseases at the National Institutes of Health who focuses on the diagnosis and management of primary immunodeficiencies. Dr. Freeman received her medical training at Georgetown University Medical School, completed her pediatric residency training at Yale New Haven Children’s hospital and her pediatric infectious diseases fellowship at Northwestern’s program in Chicago. She then joined NIH as an attending physician, briefly focusing on pediatric HIV and then changing her focus to primary immunodeficiency. Her primary focus is Hyper IgE syndromes, and she has been involved in the initial genetic diagnosis of multiple of these syndromes, and is recognized worldwide as an expert in the management of these patients due to her large cohorts of patients followed at NIAID. She also directs the primary immunodeficiency clinic at NIAID in which she educates the allergy/immunology fellows in the diagnosis and management of individuals with complex primary immunodeficiencies. Dr. Freeman has over 130 peer-reviewed journal articles, multiple book chapters and reviews, and has been a speaker in many national and international conferences on the topic of primary immunodeficiencies.
As Dr. Freeman explains, there are still a lot of unanswered questions about COVID-19. She first spoke on Episode #24, and I wanted to have her back to talk about what the pandemic has been like for her and her patients, who are all people who have primary immunodeficiencies (like me). Given that lots of states and countries are now reopening, despite the fact that the pandemic is far from over, I also wanted to get her input on how people who are immunocompromised can navigate the new normal. On today’s episode, Dr. Freeman and I talk about why, at this point, there isn’t a lot of information about how COVID-19 impacts people who are immunocompromised. We also discuss the complexities around antibody testing, and why right now, the results from antibody tests are probably more useful to epidemiologists than to individuals who are wondering if they had or didn’t have the virus. Finally, we talk about the COVID-19 vaccine: how its effectiveness might be tested and how it might be distributed. And to be fair, even though Dr. Freeman underscored that there’s a lot we don’t know, I learned an incredible amount from this conversation--she’s an absolute wealth of knowledge.
“I think for everybody right now, it’s kind of this period of time where people don’t know exactly what reopening really should look like, and especially for people that have underlying health conditions.”
Here are some of the things Dr. Freeman and I chatted about:
How we should view the “new normal”, whether we have underlying health conditions or not
The fact that there are still unknowns about COVID-19’s risk for immunocompromised people
With immunocompromised people are limiting their exposure (a good thing!), the lack of data
What we’ve learned about how the virus is transmitted, and how that’s informed mask wearing
Why the guidance is to keep six feet of distance from others while also wearing a mask
The anxiety-provoking the early months of the pandemic, and what it was like to go to work
The precautions that the NIH is taking to keep its physicians and patients safe during this time
The elements of this novel coronavirus that are so different from what we’re used to seeing
Antibody testing, and how right now it makes more sense for research than patient care
The complexity of antibody testing when it comes to those who are immunocompromised
Shifting to a different kind of telemedicine with patients, considering she already did a lot of it
The challenges of working remotely when, as a physician, her job is in no way based at home
What we might expect when it comes to a vaccine, including how it might be distributed
The way some previous vaccines have been tested in populations, but why that’s tricky here
How COVID-19 has disproportionately affected people of color, highlighting inequities in access to care
“We don’t know, but we’re trying to use our combination of common sense and what we do know now to try to help people make decisions. It’s been really hard, but everyone’s been learning together.”
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