Health Newsfeed – Johns Hopkins Medicine Podcasts

Anchor lead: Questions about how viruses, especially Sars-CoV2, spread, remain, Elizabeth Tracey reports

Can you get Covid-19 from a cell phone? How about if you enter a room where someone with the infection has been recently but they’ve left? Aaron Milstone, an infectious diseases expert at Johns Hopkins, says most research points to what are known as droplets as the most likely means of transmission but other means are possible.

Milstone: There’s also the question of whether or not these viruses can aerosolize. Can they get into the environment and spread farther distances? Droplets fall out of the air usually within about six feet around you, which is where that six foot distance comes from, but the concern is whether these aerosols can get into the air and spread much farther. Sars-CoV2 doesn’t seem to be quite as contagious and so although we think it’s possible we think it’s less likely. There’s also the question about inanimate surfaces. These are probably less common.   :29

Milstone recommends extra caution rather than overconfidence until a more complete picture of transmission risk is known. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: You can reduce your chances of both Covid-19 and the flu, Elizabeth Tracey reports

Getting both Sars-CoV2 and the flu, called ‘coinfection,’ sounds like a nightmare, but based on previous experience with respiratory viruses it is possible. Aaron Milstone, an infectious diseases expert at Johns Hopkins, says there are several steps you can take to avoid such an outcome.

Milstone: We really want to encourage everyone to get the influenza vaccine to avoid that case where someone may get coinfected with both influenza and Covid-19. So this is an especially important year to protect people from influenza. The Sars-CoV2 virus is similar to influenza in that we think it primarily is spread through droplets. Interventions we put in place, things like masking, distancing, hand washing, practicing cough etiquette, those are things that will help the primary spread of both viruses.   :30 

Milstone notes that in the southern hemisphere, where they have already had their flu season, these interventions helped keep flu infections very low. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How can you be tested to tell the difference between the flu and Covid-19? Elizabeth Tracey reports

Both Sars-CoV2 and the flu are circulating right now, and if you think you may have one of these infections it’s important to be tested. That’s according to Lisa Maragakis, an infectious disease expert at Johns Hopkins.

Maragakis: The gold standard for testing for respiratory viruses is PCR testing. Our hope is that soon we will have platforms for PCR that will look, from one sample, for a variety of viruses, including Sars-CoV2, influenza viruses, respiratory syncytial virus for instance.   :18

Maragakis says the likelihood of having both viruses as the same time – known as coinfection – isn’t known.

Maragakis: We don’t have a lot of information yet about coinfection but what we do know is that more than one respiratory virus can infect a person at the same time. So we often see coinfection with other types of respiratory viruses and we have reason to believe that that will be the case this time as well.  :19

At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How can you tell if you’ve got Covid, the flu, or both? Elizabeth Tracey reports

Think you might have Covid-19, or maybe the flu? This year it’s important to seek medical care so you can be tested. That’s according to Aaron Milstone, an infectious disease expert at Johns Hopkins.

Milstone: People who have either Covid-19 or the influenza virus can have similar symptoms. Fever, cough, gastrointestinal symptoms like vomiting and diarrhea, muscle aches, sore throat. There are some symptoms that seem to be more common with Covid-19: the loss or inability to smell or taste. People who get sicker with Covid-19 can also develop difficulty breathing. So I think the take home is that it would be really important for people to seek care and get tested to identify which virus they have.  :30

Milstone says that treatment and management strategies for Covid-19 and the flu differ in some ways, so knowing which one you have can impact medications that may be prescribed as well as symptoms you may want to watch out for. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: What can we expect as we head into the flu season? Elizabeth Tracey reports

It’s flu season now in the United States and other parts of the northern hemisphere, and Sars-CoV2 is more active than ever. Lisa Maragakis, an infectious diseases expert at Johns Hopkins, says even more respiratory infections are likely as we enter the winter months.

Maragakis: As we head into influenza season we are going to have multiple respiratory infections and viruses circulating. Up until this point and until the summer in the northern hemisphere, almost any respiratory symptoms has indicated Covid-19 likely, that is caused by the Sars-CoV2 coronavirus. Influenza is a distinct viral infection, a respiratory infection caused by one of several strains of the influenza virus family. Most notably we can prevent them in some of the same ways.   :32

Maragakis reiterates the importance of physical distancing and masking as well as washing hands and staying away from others if you’re not feel well, and getting a flu shot as soon as possible. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Adolescent depression rates appear to be increasing, Elizabeth Tracey reports

FDA warnings about the danger of antidepressant medicines in adolescents may have made the problem worse, a recent study looking at suicides in this age group found. Karen Swartz, an adolescent depression expert at Johns Hopkins, cites another worrisome study.

Swartz: Another recent survey showed that 50% of 18-24 year olds hit the threshold for a depression screen, and 25% of them said  they thought about suicide in the last thirty days.  :11

Swartz says while the problem is acute, patience is needed in treatment.

Swartz: What often happens too is that someone will come into care, when their symptoms are bad, but the medicines frustratingly take a while to work, so it might be that their intensity of symptoms actually worsens, in the time that you’re waiting for the antidepressant to work, so someone might be okay, but then they get worse because their illness is getting worse, and the antidepressant hasn’t had a chance to work yet.  :23

Swartz notes close monitoring is key. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: An FDA warning may have contributed to depression-related death among the nation’s youth, Elizabeth Tracey reports

The FDA warned in 2003 that taking antidepressant medicines might contribute to suicidal thoughts and behaviors among children and adolescents, and required what’s called a ‘black box’ warning to clinicians who prescribe them about the possibility. Since then an excess of suicides has occurred. Karen Swartz, an expert in adolescent depression at Johns Hopkins, says the risk is not in taking an antidepressant.

Swartz: What’s more of a risk is that without careful close monitoring you might start an antidepressant but not continue it, or you might get just better enough that you’re actually at higher risk, because when you first get better you might be having thoughts but now you have enough energy to act on the thought. The way to handle this is to absolutely not not treat the depression, because many many more children will die because of depression that from any complications of antidepressants. The key is to make sure that when you’re starting an antidepressant that the young people have adequate follow up and close monitoring.  :34

At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: If you have heart failure but not diabetes, should you consider a diabetes drug? Elizabeth Tracey reports

Medications for diabetes known as SGLT2 inhibitors have been shown to reduce hospitalization and death for people with one type of heart failure, even if they don’t have diabetes. Rita Kalyani, a diabetes expert at Johns Hopkins, says this is great news but comes with cautions about this class of medicines, especially for the risk of hypoglycemia, or low blood sugar.

Kalyani: They do have quite significant and quite good magnitude reduction in heart failure hospitalization. There’s great evidence now to suggest their benefit in this population. We do have to be worried about hypoglycemia. These are not a class of agents that have high risk of hypoglycemia, we don’t think about it as a major complication but it can occur, and so I think we need to better understand how do we monitor the risk of hypoglycemia in these patients that are using them when they don’t have diabetes?  :30

At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Two diabetes drugs may benefit people with heart failure, Elizabeth Tracey reports

A diabetes drug with the tongue-twisting name ‘empagliflozin’ reduced both hospitalizations for heart failure as well as cardiovascular death in people with one type of heart failure, a study known by the acronym EMPEROR has found. Rita Kalyani, a diabetes expert at Johns Hopkins, says the results are consistent with previous research.

Kalyani: Some agents in the newer classes, GLP1 receptor agonists and SGLT2 inhibitors, have superiority in reducing cardiovascular events in those who are at high risk or have previous history of cardiovascular disease. What was interesting about the EMPEROR trial was that they were looking at heart failure hospitalizations or cardiovascular death in people who had diabetes or did not have diabetes. So it was exciting because it was not just people with diabetes but also people without.  :31

Kalyani says the benefit in those with heart failure but without diabetes was novel and needs to be confirmed. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Can a diabetes drug help reduce Alzheimer’s risk? Elizabeth Tracey reports

Metformin is the first line medication for type 2 diabetes, and now an Australian study has shown that people taking it experience less Alzheimer’s disease compared to those not taking the drug. Rita Kalyani, a diabetes expert at Johns Hopkins, says the observation fits with what’s known about diabetes.

Kalyani: The link with potential cognitive function has been recently reported. We know that people with type 2 diabetes also are at greater risk of developing dementia. Dementia has been called type 3 diabetes or insulin resistance of the brain, and we do know that there is insulin signaling and insulin receptors in the brain as well. So this recent study that reported the benefit of metformin potentially in cognitive function from a plausibility perspective, is not surprising.  :30

Kalyani says other studies have shown that metformin may also improve longevity, but it’s far too early to take the drug for either of these reasons in the absence of diabetes. At Johns Hopkins, I’m Elizabeth Tracey.