Health Newsfeed – Johns Hopkins Medicine Podcasts

When people say they won’t get a Covid-19 vaccine, that’s called ‘vaccine hesitancy,’ and while one person’s individual decision not to be vaccinated may not seem like much, since we need the majority of people to get the shot to protect us all, recent data suggesting that that number is declining is good news. Michelle Patch, assistant professor at the Johns Hopkins School of Nursing, has been helping vaccination efforts in the region.

Patch: Understandably I think a lot of individuals from various backgrounds have had a bit of worry about this. It seems to have happened very quickly, and so is it safe? Is it right for me? We know that those behind the scenes at FDA, CDC, have an emergency use authorization but that does not preclude all of the safety checks that need to happen.  :28

Most estimates say only about 25% of people remain unwilling to get the vaccine. At Johns Hopkins, I’m Elizabeth Tracey.

If you’ve been fully vaccinated, the Centers for Disease Control and Prevention recommend that travel is low risk. Yet Aaron Milstone, a pediatric infectious diseases expert at Johns Hopkins, says those guidelines don’t apply to children.

Milstone: The CDC came out and has given people the green light to travel if they’ve been vaccinated. For many of us that doesn’t include our kids who are under the age of 16. The premise of traveling with your kids is people have this perception that kids are not going to get Covid and are not going to get sick from Covid. We know that’s not true. I’ve encouraged people, as they ponder traveling, which we all want to do, we’re all ready to get out, to remember that our kids are still susceptible, and although they aren’t as high risk as our grandparents there is risk.  :30 

Milstone notes that infection rates around the country are once again rising, and many younger people are becoming infected. He says keeping our children safe relies even more on masks and other measures until a vaccine for them becomes available. At Johns Hopkins, I’m Elizabeth Tracey.

Sars-CoV2 variants are spreading apace around the US and the world, even as scientists race to assess whether currently available vaccines will provide protection against them. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, says the presence of variants is not his primary concern.

Garibaldi: With the variants right now, I’m not worried about the ones that are circulating in terms of preventing us from being safe if you’ve been vaccinated, but the longer we allow high levels of community circulation of this virus, the more likely it is that there is going to be a variant that eventually is going to emerge that is going to start infecting people at a higher rate who have been vaccinated, and then we’re going to have to start the process all over again. And I think having this degree of community spread in our country but also if you look at what’s happening in India and Brazil, those are going to be hotbeds of variants if we don’t get things under control.  :31

The advice remains to keep up distancing, masks, and avoiding crowds, Garibaldi notes, and getting vaccinated as soon as possible. At Johns Hopkins, I’m Elizabeth Tracey.

Everywhere you look it seems more people are being infected with the coronavirus, with hospitalizations also rising around the US and the world. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, says weariness is pervasive.

Garibaldi: I’m disappointed. Everyone’s tired. Everybody’s tired of not doing the things you want to do. Spring is here and you want to go out, you want to do the things you’re used to doing in the spring. You want to be with your friends, you want to be at large gatherings, you want to be at holidays. And I think we’re seeing those effects with what’s happening with the numbers. Obviously every state is a little bit different but the majority of states are reporting an increase in cases, an increase in hospitalizations. An increase in ICU level care, the numbers are going straight up again. What we don’t yet know is at what point we’re going to temper that with the benefits of the vaccine.  :30

Garibaldi notes that the recent pause of the J and J vaccine will inevitably slow down the pace of immunizations, and provide an opportunity for additional spread of the virus. At Johns Hopkins, I’m Elizabeth Tracey.

Alzheimer’s disease now joins the list of conditions associated with greater risk when it comes to Covid-19, a recent study demonstrates. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, explains why that might be so.

Garibaldi: In general people who have dementia or advanced neurological illness oftentimes they will end up having problems protecting their airways following having recurring infections, pneumonia. Part of it could be related to, if you look at our initial population who got admitted from nursing homes about half of them had dementia. We know that that was a high risk group independent of dementia living in a nursing facility or being in that environment, particularly early on that was a risk for severe disease and even death. There’s also speculation that people with dementia are less able to report their symptoms.  :31

For now Garibaldi says the data clearly point to the need to protect those with Alzheimer’s disease and other forms of dementia from being infected with the coronavirus, and to vaccinate as soon as possible. At Johns Hopkins, I’m Elizabeth Tracey.

A cell phone app used in the UK has helped researchers track many of the symptoms of the syndrome known as ‘long Covid.’ Brian Garibaldi, a critical care medicine expert at Johns Hopkins, says this data provides just one part of an emerging picture.

Garibaldi: NIH has clearly identified this appropriately as an important issue to tackle, and I think we really do need these longitudinal studies to better unpack what these symptoms are because a lot of what we’re seeing are self-described symptoms like in the study that came out of the UK looking at a cell phone based app tracking symptoms and showing that up to a third of people are having symptoms 28 days later particularly if they’ve been hospitalized. Those are important data but there are limitations to how far you can take that because those are people who have self-selected to continue putting their symptoms in the app before they got Covid and after they got sick.  :30

Garibaldi says more inclusive studies including those who don’t opt in to cell phone tracking are needed, and will point the way to interventions to help. He notes that a close look at many viral illnesses reveals persistent symptoms. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Is long Covid more than one condition? Elizabeth Tracey reports

Long Covid refers to symptoms of Covid-19 infection that persist for long periods of time, and some people who report it say their symptoms resolved after they got vaccinated against the virus. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, reviews what’s known so far.

Garibaldi: By most reports right now and these are anecdotal it’s forty or fifty percent of people who are maybe getting better, and since we know that by and large people are developing immune responses to the vaccine, in those people it’s probably not a persistent low level viral infection that’s causing the problem. So I think what we’re going to find out is that long Covid, or if you want to call it post acute sequelae of Covid or PASC which is what the NIH has called it, it’s a heterogeneous disease. For some people it’s going to be predominantly neurological, for other people it’s going to be cardiovascular, others it’s going to be pulmonary, we may end up finding that these different types of long Covid are actually caused by different things.  :33

For now Garibaldi says get the vaccine, since it is recommended. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Does getting a vaccine help people who have long term symptoms after Covid-19 infection? Elizabeth Tracey reports

Some people who’ve reported long term symptoms of Covid-19 infection and have gotten a vaccine against the virus report that their symptoms resolved. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, considers why that might be so.

Garibaldi: It is possible that re-exposing someone to the antigens of the virus could somehow either reset the immune system or alter that immune response such that you no longer have prolonged inflammation. There’s also some component of people’s response to all the stressors of the pandemic, and this is not to say  that long Covid is attributable to people’s response to psychological stressors, but I think there could be some component of the symptoms that are related to that and getting a vaccine could have powerful implications for how people are coping with what’s happening around them and knowing that they’re now protected. I think the truth is we don’t know.   :30

Garibaldi notes that vaccination is recommended for those who’ve had Covid-19 so much more data is being gathered on the phenomenon. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Can monoclonal antibodies help transplant patients avoid severe Covid-19? Elizabeth Tracey reports

People who’ve received an organ transplant don’t respond effectively to Covid-19 vaccines, a study by Dorry Segev, a transplant surgeon at Johns Hopkins, and colleagues has found. Segev says there is a strategy to help, however.

Segev: In the meantime, if you’re a transplant patient and you’ve gotten vaccinated and you don’t have antibodies, if you are exposed to Covid then certainly post-exposure monoclonal antibody treatment is a very very good option, and one of my hopes is that when pre-exposure prophylaxis becomes more readily available, we’ll be able to use monoclonals for pre-exposure prophylaxis in transplant patients to buy them more time, until we reach herd immunity or otherwise figure out what’s happening immunologically.  :30

Segev says monoclonal antibodies must be administered intravenously, so if you have had a transplant and been exposed to Covid-19, get in touch with your healthcare provider as soon as possible. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How risky is Covid-19 for transplant recipients? Elizabeth Tracey reports

People who’ve gotten organ transplants experienced more severe Covid-19 disease than many others at the beginning of the pandemic, but Dorry Segev, a transplant surgeon at Johns Hopkins, says the picture is much more optimistic today.

Segev: So far what we know is that if we treat properly we can lower the mortality risk in transplant patients down to what would be equivalent in an immunocompetent patient. At the beginning of the pandemic mortality rates in transplant patients were near forty to fifty percent. This was very very scary for transplant patients. But we’ve learned a lot. One of the things we know is that the medications that transplant patients are on to prevent rejection, also seem to prevent the immuno-inflammatory response of Covid.  :32

Segev’s recent study shows that vaccine response among transplant recipients is blunted, so he’s advocating for a third dose. At Johns Hopkins, I’m Elizabeth Tracey.