Public health pro fights coronavirus two ways
Lori Ahrenhoerster would rather be working around the clock with her colleagues in the North Shore Health Department to limit the spread of coronavirus.
But as a person with leukemia awaiting a bone marrow transplant, she’s in a high-risk group. Because her immune system is weakened by both cancer and chemotherapy, coronavirus could kill her.
Thanks to her medical condition, Ahrenhoerster has spent the past four months doing what some people recently started — washing hands thoroughly and maintaining social distance.
As the North Shore Health Department’s public health manager, she’s concerned that people aren’t taking the threat seriously enough, failing to realize that asymptomatic people can pass the virus on to more vulnerable ones.
As a patient, her “biggest, most realistic fear” is that delays caused by coronavirus will ruin her chance of being cured of leukemia. Travel uncertainties caused by the COVID-19 pandemic have already cost her one possible bone marrow donor.
Ahrenhoerster is on medical leave as she prepares for a planned April 29 transplant. But if she were at work, she would be answering calls from the public — “everyone says contact your local health department,” she said during a phone interview. Even more critically, she would be calling people who have been in contact with someone who has been confirmed with coronavirus, she said.
“It’s called disease tracing or contact tracing,” Ahrenhoerster said. A health department staff member calls each person to inform them they may have been exposed to someone who has tested positive, be it a close contact or a person who was in the same public building. The person contacted is coached on steps such as taking their temperature twice a day and monitoring a checklist of symptoms, she said.
This process, designed to limit the spread of a contagious disease like pertussis, for example, is normal work for the health department. What’s not normal is the sheer volume of coronavirus contacts, she said. “It’s just through the roof.”
‘Bullet train’ vs. the coronavirus
Ahrenhoerster was diagnosed in November with therapy-related acute myeloid leukemia (t-AML), a form of blood cancer. Her variant of leukemia is a known side effect of chemotherapy medication she received for breast cancer.
Since 2015, Ahrenhoerster has documented her breast cancer diagnosis, treatment, surgery and recovery in a blog named Mammary Irony. A strong proponent of breastfeeding, she has been a La Leche League leader, a certified lactation counselor and a “lactivist.” Breast cancer was the last kind of cancer she ever imagined she’d get.
Ahrenhoerster earned a PhD in environmental and occupational health from the University of Wisconsin-Milwaukee Zilber School of Public Health. Her doctoral research on developmental immunotoxicology included work with hematopoietic stem cells — the kind of stem cells she will receive in her transplant.
Her blog, which now reports her leukemia experiences, is a blend of factual reporting, including specific lab results, and straight talk about what she’s going through.
In the beginning, she said, keeping the blog saved her the effort of repeating the same details over and over again. Later, she realized it helped her remember things she had forgotten when she mentored breast cancer survivors through an After Breast Cancer Diagnosis (ABCD) program.
“It gave me a little bit of purpose that I was contributing in some way, which is what I most miss by not being able to work,” she said.
Late in 2019, as she neared the fiveyear anniversary of her double mastectomy, she was diagnosed with leukemia. Cytogenetic testing confirmed it was both treatment-related and aggressive. Correspondingly aggressive treatment with chemotherapy started immediately. Compared to the pace of her breast cancer journey, this is a “freaking bullet train,” she wrote in a blog post.
She needs a bone marrow transplant, and here is where the coronavirus pandemic threatens to complicate her already challenging situation.
Bone marrow makes a person’s blood cells, including their disease-fighting white blood cells, and in particular a subset of white blood cells called neutrophils, which help the immune system mount a general response to new substances attacking the body, like coronavirus.
Ahrenhoerster is so low on neutrophils that her body can’t defend itself against the virus.
Fortunately, both a primary bone marrow donor and a backup bone marrow donor were located for her, and she was on a plan designed to lead to an April transplant. But COVID-19 havoc has already delayed the bullet train at least once. Because the identified primary donor lives in another country, the treatment team decided that travel restrictions might make it impossible to get the donation when it is needed. Now the plan is for cells from the backup donor to be cryogenically frozen for a week while Ahrenhoerster gets pre-transplant chemotherapy to prepare.
“There’s always a chance that I fall out of remission the longer it goes. And I cannot have a transplant if I’m not in remission,” she said.
Also, the donor could get coronavirus, or Froedtert Hospital could become so swamped with COVID-19 patients that it wouldn’t have a room for the transplant surgery, she said.
Froedtert would not comment on an individual patient, but did issue a statement about how the coronavirus pandemic affects the care of transplant patients. “Cancer patients, like all immunocompromised patients, need to be especially vigilant at this time. Our providers are working closely with patients to determine if their transplant is safe to be deferred. We continue to follow guidelines and precautions for our most vulnerable patients,” wrote media relations associate Nalissa Wienke in an email.
“We, in conjunction with our peer health care providers, have experience in managing serious infectious diseases and pandemics and are trained and prepared,” Wienke wrote.
“Patients impacted by a deferred procedure will be contacted directly. … We encourage patients to contact their Froedtert & MCW health care provider with questions,” Wienke wrote.
Ahrenhoerster admits that it’s scary to think about the things that could go wrong.
“All you can do is go forward,” she said.
She is diligent about her own protocol. Unless there is no other option, only family members drive her to hospital appointments, currently three times a week. She wears a mask, and she takes prescribed antibacterial, antiviral and antifungal medications to keep from getting some other problem.
She also tracks news about COVID-19 incessantly.
Ahrenhoerster encourages people to take coronavirus seriously. While for some who get it it may not feel worse than a bad cold, the pool of immunochallenged people who would be drastically affected is larger than many people realize, she said.
She cautioned people not to extrapolate what they know about flu, a wellstudied illness, to COVID-19. “There is so much we don’t know about this virus yet,” she said.