Health Newsfeed – Johns Hopkins Medicine Podcasts

Anchor lead: A new treatment for those with methamphetamine use disorder points to how big a problem this has become, Elizabeth Tracey reports

Methamphetamine use is responsible for a staggering number of drug overdoses in the western and midwestern United States, with a new study describing one intervention using two medications that may help. How do we account for so much methamphetamine use in some areas of the country while opioids predominate elsewhere? Eric Strain, a substance use disorders expert at Johns Hopkins, comments.

Strain: What are the circumstances early in trying a drug versus later when you’ve become habituated to its use. The circumstances under which somebody first uses a substance tend to be governed more by the social circumstances, there might be peer pressure or maybe they’re depressed, but then as the person hones in on using the substance I think its more what is going on with that person specifically, their genetic vulnerability, thing like that, as well as physical dependence. :31

Strain notes that in parallel with the pandemic, overdose deaths have also almost doubled, the latest CDC data report. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How worried should we be about new Covid-19 variants? Elizabeth Tracey reports

Variants on the Covid-19 virus have popped up from at least three places around the world, scientists have found, with the potential for enhanced transmission person to person. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, says his main concern isn’t the existing variants, it’s the overall rate of infection.

Garibaldi: The thing that I’m more concerned about is the fact that we’ve let this virus run rampant. And with so many people who are infected it has so many more opportunities to gather these mutations that by chance, might lead to a virus that does evade the vaccines. Now it is true that these vaccines can be modified very easily the platform that they’ve used, the mRNA vaccines they can modify the mRNA so that we make an immune response to these new variants if they become problematic. Right now I don’t think we need to do that. We certainly need to see more data in people who’ve been vaccinated.  :29

Garibaldi emphasizes that the best course for us all is to keep up with masking, distancing, and limiting interactions with others and to be vaccinated as soon as possible. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Why does air pollution reduce life expectancy? Elizabeth Tracey reports

How does air pollution impact life expectancy? A recent study suggests exposure to air pollution may be a major factor accounting for differences in life expectancy among residents who live just a few miles from each other. William Checkley, a critical care medicine physician and international air pollution and health researcher at Johns Hopkins, comments.

Checkley: Any exposure to air pollution leads to inflammation in the lungs, or even throughout the body. There are multiple components that affect life expectancy in adults, whether it is that you develop a chronic respiratory disease, a cardiovascular condition, inflammation itself increases risk of stroke, of heart attacks, and also the damage of course in the lungs that also makes you more susceptible to infections. It can all be related to a decrease in life expectancy.  :29

Checkley notes that in some polluted cities internal air filters are used by those with means to reduce their exposure to particulate matter found in air pollution. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Will testing saliva for Covid-19 replace nasopharyngeal swabs? Elizabeth Tracey reports

Testing saliva for Covid-19 has multiple advantages over the gold standard nasopharyngeal swab, two new studies report. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, says these results must be viewed in context.

Garibaldi: When you think about these tests you have to think what is the reason I’m using this test? How am I going to put that positive or negative result into context? So the saliva based tests are easier, they don’t require putting a catheter up your nose so you don’t require any training to do them, they’re quicker to do, I think people will find them less invasive and less unenjoyable to get done, they’re fairly sensitive but they’re not as good as a PCR test, they’re not going to give you the same level of sensitivity so you’re going to miss cases. I think it’s a balance between if we can get more people tested it’s okay to miss a few more cases.  :32

Garibaldi says when transmission and cases are high, saliva may be okay for providing a broad picture of rates of infection in a community. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How does having two very effective vaccines complicate the vaccine picture worldwide? Elizabeth Tracey reports

The Moderna and Pfizer vaccines currently being used against Covid-19 report 90%+ efficacy, but Sinovac, the Chinese vaccine currently being used in South America, comes in at only 50.4%. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, says we shouldn’t scoff at lower efficacies. 

Garibaldi: When this all started the FDA set its bar at 50% efficacy, so the fact that the first two vaccines happen to be incredibly effective, in some ways kind of hurts the overall development. What is the threshold at which we would find a new vaccine acceptable? We said 50% when we started, now we have this great 95% vaccine, but if there’s a vaccine that’s 80%, that’s really good and if you had told us five months ago, hey we have a vaccine that’s 80% effective against this virus, you would have said, sign me up, give it to me right now.  :30

Garibaldi notes that in order to vaccinate the majority of the world’s population, several different vaccines are likely to be needed, especially ones that don’t require cold temperatures or may need only one dose. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Finding people who are willing to participate in vaccine clinical trials is becoming a problem, Elizabeth Tracey reports

While the two vaccines currently being administered in the US are reaching millions, several more are still in clinical trials to prove their efficacy, yet finding people willing to participate is getting harder and harder. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, comments.

Garibaldi: If you were faced with the choice of waiting two months to potentially get one of the vaccines that we already know is 95% effective and seems to be safe, versus enrolling in a clinical trial right now, that’s a really difficult choice. Particularly if you’re in a position where you can potentially continue to self-isolate and keep yourself and your family protected from the infection. I think its pretty clear that while the two vaccines that we have are really, really good, we don’t have enough doses for everyone in our country, and we certainly don’t have enough doses for everyone in the world, so we are going to need other vaccines.  :30

Garibaldi notes that certain age groups, especially those 65 and older, are especially difficult to recruit at the moment as federal guidelines have placed them in eligible groups for vaccination. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Even with vaccines, the need for drugs to help treat Covid-19 continues, Elizabeth Tracey reports

Vaccinations against Covid-19 are underway nationwide, but the urgent need for treatments for Covid-19 still exists and will likely continue for months. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, says the good news is there are some drugs in the pipeline to help.

Garibaldi: The hope would be that at some point we would have evidence that an oral antiviral agent would work. There’s a couple oral antiviral agents that have really good efficacy in test tubes against the virus, some animal studies suggesting they have benefit, but we just haven’t seen the results from human trials yet. That would be a game changer if we see that one of these oral therapies works then that would be amazing.  :21

Garibaldi says there is one in particular he’s excited about.

Garibaldi: It’s an oral pill, it’s EIDD2801. We’re expecting results from that sometime in the next couple of months. So hopefully it will come in time and have favorable results and we’ll be able to use it in the current outbreak.   :09

At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: While some people with early Covid-19 may respond to antibody treatment there are barriers, Elizabeth Tracey reports

Antibody treatments may help some people with Covid-19 avoid progression of the disease and subsequent hospitalization, but there are several steps that must be taken before antibodies can be used. That’s according to Brian Garibaldi, a critical care medicine expert at Johns Hopkins.

Garibaldi: One of the challenges is that in many parts of the country it can take a while to get a test back, so by the time you get your symptoms, then you get your test, then you get your results back, then these are resource intensive therapies because you have to place an IV, you have to give an infusion over at least an hour and then you have to watch someone afterwards to make sure that they tolerated it okay. These are really hard to ramp up for many health systems, and so some health systems have said we are overwhelmed right now with simply taking care of patients who are sick enough to be in the hospital, and we have to distribute vaccine, we don’t have the staff, we can’t do it.  :30

Garibaldi says it is well worth asking about the availability of antibody treatment if you have early disease or known exposures. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: What is the role of antibody treatments in Covid-19? Elizabeth Tracey reports

If you’ve been diagnosed with Covid-19, should you ask your physician to treat you with antibodies, as some former federal authorities have suggested? Brian Garibaldi, a critical care medicine expert at Johns Hopkins, reviews the evidence.

Garibaldi: There have been two outpatient trials looking at people who have symptomatic Covid. If you give them either of the two monoclonal antibody products there’s a reduction in the likelihood of them being hospitalized, but it’s a very small benefit, they’re small studies. Right now we know these are not treatments for people who have gotten sick enough to go to the hospital and it’s still unclear what their role is on a widespread scale outside of the hospital. Could you use these as a way of preventing infection in people who have likely been exposed?  :29

Another recent study found that giving antibodies to nursing home residents and staff did reduce the number who went on to develop symptomatic Covid-19 after they were known to be exposed, so ask your physician if you are a candidate for their use. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Are higher or lower oxygen levels best in patients with respiratory failure? Elizabeth Tracey reports

Acute respiratory distress syndrome or ARDS is one complication of severe Covid-19 disease, with a new study in the New England Journal of Medicine demonstrating that lower oxygen levels achieve about the same outcomes as higher ones when patients must be on ventilators. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, comments.

Garibaldi: The data goes back and forth on where we should actually target oxygen levels. The reason it’s important is that oxygen itself can be toxic. If we can find that ideal point at which we know we can minimize the amount of oxygen exposure by lowering the amount of oxygen levels that we target in patients that could be a big win. I think this latest study suggests that we probably can safely target slightly lower levels of oxygen in patients with ARDS, but the target of where we should go is not entirely clear.  :31

Garibaldi notes that using less oxygen in the ICU is unlikely to alleviate oxygen shortages in areas of the country that are experiencing them, however. At Johns Hopkins, I’m Elizabeth Tracey.