When COVID-19 Calls, an ISTH Task Force Answers

By Geoff Barnes, M.D.

April, 2020 – it seems like a lifetime ago. And in some ways, it was. At that time, we had recently learned about COVID-19, and early reports of thrombotic risk from China and Europe were being published.  With true leader’s intuition, Claire McLintock, M.D., (ISTH President at the time) assembled a diverse group of leaders to provide her and the ISTH staff with guidance on the needs of the thrombosis and hemostasis community with regards to COVID-19 and related thrombotic risks. Our group had no idea what adventures we would take over the next 12 months!

Officially titled the ISTH COVID-19 Rapid Response Task Force, members from around the globe began meeting every few weeks to review the state of the science, to brainstorm ways to educate and support clinicians and researchers, and to prioritize any number of requests coming to ISTH regarding COVID-19. As this novel coronavirus rapidly traversed the world, our group developed a series of brief webinars to educate clinicians on thromboembolic risk and expert-recommended strategies for venous thromboembolism prevention.

Rather than generate the content, we relied on a network of global experts to discuss their experiences, recommendations for applying prior evidence when caring for patients with COVID-19 and their rapidly emerging plans for clinical trials. While much of the content focused on clinical diagnosis and management, we ensured that researchers who were rapidly developing new animal models and techniques had a platform to share their findings in the hopes of quickly translating evidence into clinical advances.

The task force also spent time reviewing manuscript publications, both in press and on pre-print servers, to determine which should be catalogued at the ISTH Academy website for easy access by thrombosis and hemostasis clinicians and researchers. We also provided feedback on the most important COVID-19 topics for the ISTH 2020 meeting, which was rapidly being converted to a virtual format. While ultimately at the discretion of the local organizing committee, our Task Force was well positioned to assess the state of the science and educational needs from across the globe.

Of course, ISTH was not the only society committed to educating clinicians and the public about the risks of thrombosis with COVID-19. As different societies prepared webinars and online resources, our task force reviewed their planned content to ensure that they were scientifically rigorous and encouraged global representation among presenters.

Needless to say, mid-to-late 2020 was busy for the members of our Task Force and the ISTH staff who supported us. We continued to meet, but at a less frequent rate. Most clinicians were aware of the thrombotic risks associated with COVID-19. And while retrospective studies continued to be published, we awaited results of the many ongoing clinical trials addressing thromboembolic prevention.

December 2020 and January 2021 brought exciting news about the multi-platform randomized trials comparing prophylactic and treatment dose anticoagulation to prevent thromboembolism in hospitalized patients with COVID-19. The ISTH Task Force reviewed the press releases from the investigators and worked closely with ISTH staff to help disseminate these reports to our global community.

Then, in early March 2021, another chapter in the COVID-19 and thromboembolism story quickly began to unfold. After early reports of European patients developing cerebral sinus and splanchnic vein thromboses associated with thrombocytopenia shortly after vaccination, the Task Force determined that ISTH should issue a statement to address concerns from clinicians, policy makers, and the public.  Our initial statement on March 12, 2021 was intended to reassure the public that vaccination was a safe and highly effective strategy for controlling the COVID-19 pandemic. In just three short days, this statement reached over 450,000 people on social media and generated more than 25,000 visits to the ISTH website. 

Over the next two weeks, more details about the emerging Vaccine-induced Immune Thrombotic Thrombocytopenia (VITT) syndrome emerged. In response, our task force rapidly developed clinical guidance on approaches to diagnosis and management of this condition.  This work could not have been accomplished without the collaboration of work experts in the United Kingdom, Europe, and Canada, where the largest experience of VITT was quickly amassing.

As I reflect back on a year like none other in my lifetime, I am reminded why ISTH has become such an important part of my professional life. The ability to bring world experts together at a moment’s notice to address critical clinical and public health needs is a remarkable feat. Furthermore, I am heartened by the dedication each Task Force member had to advancing the science, spreading knowledge, and serving our global community. These world experts prioritized our Task Force’s work because they each know how valuable and impactful educational tools are when produced by ISTH.

Finally, I am impressed with the ISTH staff’s resourcefulness, creativity, and organizational ability. None of our Task Force’s work would have been possible without the talent and dedication of the volunteer members and the ISTH staff.

I’m not sure how history will judge the world’s response to COVID-19. But within our thrombosis and hemostasis community, I am proud of how quickly the ISTH rose to meet the many needs of our global membership. I am thankful to have been included among the many thoughtful, dedicated, and caring experts who served on the ISTH COVID-19 Rapid Response Task Force – whom I now consider both colleagues and friends.