Health Newsfeed – Johns Hopkins Medicine Podcasts

Researchers around the world are sequencing new variants of Sars-CoV2 as they emerge, but while it may be possible to pinpoint changes in the virus it’s not known what those changes might portend. That’s according to Stuart Ray, an infectious disease expert at Johns Hopkins.

Ray: Here I am noting that delta lacks those changes in most of the sequences, so while we thought 501, 44 were super important, this virus continues to surprise us, and delta has other features. So what we thought was important before may not be important now, and I think this is important as we think about where the next variant might come from. They keep on coming out of left field and so we have to be humble about our ability to predict what’s going to be dominant six months from now if we’re designing a new antigen for a vaccine for instance.  :29

Ray says that current vaccines are holding their own against all important variants of Sars-CoV2, dramatically reducing both hospitalizations and deaths related to infection. At Johns Hopkins, I’m Elizabeth Tracey.

Alpha, Beta, Delta, and most recently Mu. Variants of Sars-CoV2 are constantly arising but only some of them reach the level where they are monitored. Stuart Ray, an infectious disease expert at Johns Hopkins, explains.

Ray: We see variants arising all the time. But occasionally a variant will have genetic features, that are features that have been associated with changes in variants that have become dominant. Those mutations of interest can qualify a variant as being a variant of interest. They become variants of concern when they spread enough to play a significant role in the epidemic. Some observations of increased transmissibility, partial evasion of immune responses and so that makes them variants of concern.  :29

The World Health Organization developed the naming convention for Sars-CoV2 variants based on the Greek alphabet, which was welcomed by many because it simplifies communications about which ones are spreading most easily in different parts of the world, and may also help in developing vaccines. At Johns Hopkins, I’m Elizabeth Tracey.

The spread of the delta variant of Covid-19 may have reached a plateau in the United States, the most recent data suggest. Many have pointed to unvaccinated people as the primary driver of this latest surge. Mark Sulkowski, an infectious disease expert at Johns Hopkins, says optimism early in the summer contributed.

Sulkowski: One of the other factors was this return to normal activity. A poll taken in June where one out of three Americans thought we had turned the corner and optimism was reaching a peak – 89% of people were optimistic about the coronavirus situation- as they called it in the poll. Domestic and international travel, just a resurgence of travel as well, so people were getting back to normal activities, we went to reductions in mask wearing requirements and things like that, which are now reversed.  :31

Sulkowski says knowing the range of factors that helped the virus spread are informative in controlling it as well as helping people reduce their own risk. At Johns Hopkins, I’m Elizabeth Tracey.

Shutdown and transition to virtual school was tough on everyone, and now returning to school in person for many is also providing challenges. Jennifer Katzenstein, a child psychologist at Johns Hopkins, says this is all normal.

Katzenstein: (Jennifer) There’s a range of emotions as kids return to school, especially after virtual school for the length of time that they’ve been in virtual school. One of those may be relief, returning to the school setting, returning to their social interactions. But there also may be anxiety and worry, about returning to school with the demands of the school day. What I’m seeing, especially for our middle schoolers, is more uncertainty and anxiety, especially now that they’re changing classes. So for some of the kids going back to school is a big jump developmentally that can be causing anxiety and stress.  :29

Katzenstein says parents should try to be aware both of their children’s emotions as well as their own as we all accustom ourselves to the new routine. She advises seeking help if any issues seem to be worsening or if parents are feeling overwhelmed. At Johns Hopkins, I’m Elizabeth Tracey.

Covid-19 infection can be frightening for anyone, and now that kids are back in school many parents are more worried than ever. Aaron Milstone, a pediatric infectious disease expert at Johns Hopkins, says if parents are worried about a child’s symptoms they should not hesitate to reach out.

Milstone: I know one of the common questions I get is about what should be that threshold for parents to seek attention and go to their doctor. And I always tell parents if you’re worried it’s always okay to check in with your doctor. I mean there’s no harm in calling, scheduling an appointment and getting checked out. This year when kids have symptoms it’s equally important to get tested, cause we really need to know if kids have COVID so we can appropriately keep them away from their family members and other students, to keep their community safe.  :26

Milstone reminds parents that they really know their own child best, so when parents feel concerned it’s worth following up. Early recognition and management of a worsening condition is more likely to resolve well. At Johns Hopkins, I’m Elizabeth Tracey.

Mask or no mask? While for adults that may be a decision, most school districts around the country have opted in for this strategy to reduce Covid-19 transmission among their students. Aaron Milstone, a pediatric infectious disease expert at Johns Hopkins, comments.

Milstone: We’ve learned over time that masks really do help kids to stay in school. Not only are they going to prevent the spread of COVID virus this year, where we learned last year is they help prevent the spread of other respiratory viruses, like influenza, the common cold, even the illnesses that give kids vomiting and diarrhea in the winter. All those other viruses are equally disruptive for families so not only will masks help curb COVID spread but hopefully they’ll keep kids healthy this winter, and in school.  :26

Milstone points to soaring rates of infectious diseases like respiratory syncytial virus or RSV, around the country as masks and distancing have been relaxed or abandoned as evidence that these physical barriers have real benefits. He notes that parents may consider setting a good example by wearing mask also. At Johns Hopkins, I’m Elizabeth Tracey.

Now that most children are back in school, the majority of them in person, parents and kids need to continue their vigilance against becoming infected with COVID. Allison Agwu, a pediatric infectious diseases expert at Johns Hopkins, says that starts with masking up.

Agwu: Masks, masks and more masks, and I think even if masks are not being required really masking in schools and out of schools, to protect yourself, particularly in indoor spaces or where you can’t guarantee the distancing. Many schools are putting in distancing within the desks, the lunch, etc, and emphasizing the importance if your school doesn’t have that, of masking, distancing and making sure you’re being safe, a few schools don’t do that, most are, and talking to your kids about abiding by those rules for masking and distancing  .:27

Agwu notes that parents can help their kids by making sure they’ve got more than one mask on hand if one is soiled, and helping them run through strategies to avoid risking contagion in settings like sports or the cafeteria. She says parental support is critical. At Johns Hopkins, I’m Elizabeth Tracey.

Kids are back in school in person now in many parts of the United States and the world, yet both they and their parents are still worried about activities and contagion risk, especially in children younger than 12 years of age and others not yet vaccinated. Aaron Milstone, a pediatric infectious disease expert at Johns Hopkins, offers some words of encouragement.

Milstone: Kids are frustrated because they feel that things are being taken away from them. And I keep telling parents that parents are creative and resilient and we can find fun things for our kids to do, even in this pandemic. And we did that last year. So even in this fourth wave, even as we go through the winter, I mean parents really need to set a positive tone for their kids and say we can find fun and safe things for you to do. Put your mask on, get your vaccine, and if we’re smart we can continue to let kids enjoy the kind of day to day stuff and going back to school.  :28

Milstone says preparation is everything, including providing masks and backups to kids, helping kids strategize on ways to stay safe even if they’re among unmasked people, and being reassuring. At Johns Hopkins, I’m Elizabeth Tracey.

Antibodies donated by people who’ve recovered from COVID infection, known as convalescent plasma, is a therapy that does have emergency use authorization by the FDA, and that must be given to hospitalized people early in the course of infection. Arturo Casadevall, a convalescent plasma expert at Johns Hopkins, says timing is critical.

Casadevall: It is important to know that there is a therapy that the FDA has on its emergency use authorization that has been underused. Patients it would great if they had a discussion with their physician. And it would be great if the physicians who admitted them to the hospital took the time to familiarize themselves as to what the available data is. It is mixed, we are the first ones to admit it. But that has to be taken in the view that it is relatively safe, the evidence is that if it is used early that is where the studies are showing the efficacy in reducing mortality. :33

Casadevall says people who are admitted to the hospital should ask their physicians if they are candidates for this therapy, which he says helps many avoid severe COVID. At Johns Hopkins, I’m Elizabeth Tracey.

A treatment known as convalescent plasma, which is basically antibodies from someone who’s already recovered from COVID, can help in early COVID infection, but the caveat is early. Arturo Casadevall, a convalescent plasma expert at Johns Hopkins, says for people with certain health conditions, seeking early treatment is a wise idea.

Casadevall: The public needs to know that there are therapies available that work best if you seek early care. So if one is diabetic, if one has hypertension, if one has lung disease, it’s better to seek help when you have symptoms than to wait until you call EMS to come bring you in. Doctors in the emergency room, plasma can only be given to hospitalized patients, so once you make that decision to admit, that is the time to give them plasma.  :29

Casadevall and colleagues have recently linked increased rates of death due to COVID to reduced use of convalescent plasma, a treatment he calles largely safe and cost-effective. He hopes people will ask their physicians about it. At Johns Hopkins, I’m Elizabeth Tracey.