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• According to the World Health Organization (WHO), tobacco kills up to half of its users
• Teenage girls who smoke are especially vulnerable to developing breast cancer later in life
• In South Africa, Protect Our Next aims to improve tobacco control legislation and educate the public on its harmful effects 

The month of October is breast cancer awareness month.

It marks a special time for survivors of breast cancer, reminding them of what they have overcome. It is also a painful reminder of the dreadful effect of the disease on those who have lost loved ones as a result. Most importantly, Breast Cancer Awareness Month allows us to reflect and educate ourselves on ways in which we can lower our risk of developing cancer.

Protect Our Next is a partnership between CANSA, the National Council Against Smoking (NCAS), the South African Medical Research Council (SAMFC), and the Heart and Stroke Foundation South Africa (HSFSA). The aim of this partnership is to improve tobacco control legislation and also educate the public on the harmful effects of tobacco usage. 

Lowering the risk of developing cancer

In a press release, Protect Our Next recently expressed that teenage girls who smoke are especially vulnerable to developing breast cancer later in life. The risk is even higher for those who have a family history of cancer.

While the risk for breast cancer can be due to family history, a study published in the Journal of Breast Cancer confirmed that smoking is associated with an increased risk of breast cancer. A fact sheet on the World Health Organization (WHO) website also shows that tobacco kills up to half of its users. 

Controlling the consumption of tobacco, especially among the youth, is therefore a vital part of lowering the risk of developing cancer. Lorraine Govender of the Cancer Association of South Africa (CANSA) expressed, “We must ensure that we have policies in place that protect young people from these toxic, carcinogenic products. Too many lives are lost through cancers resulting from tobacco addiction, and we need to reduce every risk factor.”

Govender went on to say that implementing a new Bill that makes it harder to obtain and use tobacco-related products will be a step in the right direction.

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Virginia Van Wyk

• There is a different Covid-19 phenomenon called ‘Multisystem Inflammatory Syndrome in Adults’ – or MIS-A 
• This is affecting patients’ heart, digestive tract and nervous systems 
• MIS-A might not be driven directly by the virus itself but by a post-infectious immunologic response 

When the new coronavirus pandemic first began, respiratory distress immediately became the hallmark of severe Covid-19 illness. News reports focused on the inability to breathe, low oxygen saturation levels and the alarming need for ventilators.

But six months later, experts are becoming increasingly concerned about a very different Covid-19 phenomenon, one that spares the lungs only to take direct aim at the patient’s heart, digestive tract and nervous system.

Called “Multisystem Inflammatory Syndrome in Adults” – or MIS-A – the condition was first spotted last spring in children and teens.

“The symptoms are very similar among adults and children,” explained Dr Alisa Femia, director of both in-patient dermatology and autoimmune connective tissue disease at NYU Langone Dermatologic Surgery & Cosmetic Associates, in New York City.

A shock-like state

“Fever is characteristic,” Femia noted, sometimes accompanied by a rash, skin discolouration and chapping, chest pain and gastrointestinal issues.

“Some patients develop muscle pain and a general feeling of unwellness. And some experience a shock-like state, which means that blood pressure is dropping, the heart rate is up, and the patient appears very, very ill and in immediate need of hospitalisation,” she added.

Femia was part of a team that first reported on the paediatric version of the condition – known as MIS-C – back in July. To date, there have been more than 1 000 cases of MIS-C in the United States, resulting in 20 deaths.

Femia ultimately went on to treat the first reported case of MIS-A. Now, the US Centers for Disease Control and Prevention is zeroing in on the adult version, with an analysis outlined recently in the CDC’s Morbidity and Mortality Weekly Report.

The CDC report focused on 27 MIS-A patients ranging in age from 21 to 50. Of those, 10 ended up in the intensive care unit and two of those patients died.

“The lack of respiratory symptoms at presentation represent the main distinction between patients with severe Covid-19 and MIS-A,” said Dr Sapna Bamrah Morris, lead author of the CDC report. She’s an infectious disease specialist and clinical lead of the Health Care Systems and Worker Safety Task Force for the CDC’s Covid-19 Response Team.

In fact, said Morris, in some cases, MIS-A patients “may have multiorgan dysfunction without [any] history of showing symptoms of Covid-19”.

Many patients show no ‘typical’ COVID-19 symptoms

That speaks to the bewildering nature of MIS-A, Femia said. MIS-A patients are testing positive for Covid-19 antibodies, but absent classic respiratory symptoms, many had no idea they were infected. But several weeks or even months later, they suddenly end up hospitalised with serious MIS-A symptoms. At that point, they are often no longer positive for active Covid-19.

“The timing of all of this is very difficult to establish,” Femia said. “We really don’t know how long after an infection with Covid this can happen, because antibodies can remain positive for a couple of months. I would say that, from a doctor’s perspective, our best guess is that this is likely to happen four to six weeks after infection, but it could be three to four months. We really don’t know.”

Dr David Hirschwerk is an infectious disease specialist at Northwell Health in Manhasset, New York. “The timing of all of this suggests that MIS-A is driven not directly by the virus itself but by a post-infectious immunologic response that causes damage to the body,” he said.

“We think that it is relatively rare,” Hirschwerk added. “But we are all on the lookout for it now.”

Femia acknowledged that wasn’t always the case, given that in the early days of the pandemic “hospitals were overwhelmed, and it was a new disease, and this condition just wasn’t on the radar, which means we honestly don’t really know how many adults have gotten this”.

So, who is most at risk for MIS-A? Hirschwerk pointed to the CDC finding that “the vast majority of patients with MIS-A belonged to racial or ethnic minority groups”.

More prevalent in children

But, “like many things with Covid-19, it is all very new to us,” he added. “It requires more study, more data and more time.”

Femia agreed. But she noted that some characteristics of MIS-A are becoming both clear and worrisome. For example, “this has been seen in otherwise healthy patients, as well as among patients with underlying conditions, like obesity. So, the overall suspicion is that you probably don’t need as may co-morbidities to be at risk,” she explained.

“MIS also seems to be more prevalent in children than adults,” she noted. “Why, we just don’t know.”

The good news: “It is treatable,” Femia said. Apart from anti-clotting meds and aspirin, “the most consistent treatment that’s given is IV immunoglobulins”, which are proteins that function as antibodies. “We don’t usually use that to treat acute Covid infection, but it’s borrowed from treatments for other hyper-inflammatory conditions, like Kawasaki disease,” a pediatric illness that causes blood vessel inflammation.

“There’s a lot we don’t know about this,” said Femia. “And many patients will have a very difficult hospital course before they come back to health. But in the end, the majority of patients do survive.”

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