Health Newsfeed – Johns Hopkins Medicine Podcasts

Anchor lead: Data are accumulating on infection and death relative to Covid-19 among healthcare workers, Elizabeth Tracey reports

Even with personal protective equipment, a recent Lancet study reports that healthcare workers are more than three times as likely to contract Covid-19 as people who don’t work in healthcare, while death rates are disturbingly high also. Patricia Davidson, dean of the Johns Hopkins School of Nursing, says more intensive study is needed.

Davidson: One of the things that has been very troublesome to many people around the world has been the number of healthcare worker deaths. More than that is how little we know about the numbers of people that have died. In nursing homes there’s been about 767 deaths reported amongst healthcare workers. I think this is a time where we really need to look at our occupational health and safety models, to make sure our healthcare workers are protected.  :30

Davidson notes that procedures for donning and doffing protective equipment, especially in taking it off, need greater scrutiny, with those institutions that are vigilant keeping risks lower. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: What are the challenges of HIV care during the Covid pandemic? Elizabeth Tracey reports

HIV and TB are poised to resurge following Covid-19, public health experts warn in a recent Lancet publication. Joseph Cofrancesco, an HIV expert at Johns Hopkins, says challenges facing those with HIV here in the US underscore conditions that make resurgence more likely.

Cofrancesco: The day to day operations for patients are tougher. Virtual visits, though very good, are not quite the same as live visits, and many of the patients in my own practice and certainly in the United States simply don’t have the technology, or frankly the finances to have the technology, to do those kinds of visits. I’ve had at least one or two patients tell me they’ve had an interruption in their meds for a few days, because the pharmacy couldn’t get it.  :28

Cofrancesco says that if such barriers are present in a high resource setting like the US even more profound challenges face those in low and middle income countries. He hopes that a Covid vaccine will soon be available so other important health issues also get attention. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Public health experts are sounding warnings about more HIV in the wake of Covid-19, Elizabeth Tracey reports

As the world’s attention is taken up by Covid-19, will we see resurgences of TB and HIV? That’s the concern of global public health experts, who warn that just as is the case with Covid-19, no country will remain unaffected by increases in these two infectious diseases. Joseph Cofrancesco, an HIV expert at Johns Hopkins, comments.

Cofrancesco: The pessimist in me says clearly this is going to disrupt things and make for horrible problems. The Lancet Global Health published the article that looked at this and said, based upon this different modeling that the worst case scenario is that there will be 10% more deaths worldwide due to HIV in the next five years. Now that’s modeling but its pretty good modeling. The optimist in me says we will get a vaccine and we’ll get this under control.   :31

Cofrancesco notes that both HIV and TB rates were declining globally with worldwide public health cooperation, and hopes that will resume. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Does having HIV put someone at higher risk for severe Covid infection? Elizabeth Tracey reports

Covid-19 is putting worldwide efforts to contain both HIV and tuberculosis at risk, after the best year yet for containment in 2018. Joseph Cofrancesco, an HIV expert at Johns Hopkins, says it still isn’t known exactly how Covid infection affects someone with HIV.

Cofrancesco: There’s some thought that if you are well controlled and you’re taking your meds and you have a high CD4 count, your risk should not be substantially higher than than someone who doesn’t have HIV. But the lower your CD4 count and certainly if you’re not on treatment your risk would be substantially higher. There are however some suggestions at least but I don’t think we have the data yet to support it that HIV itself may be an independent risk for having more severe illness with COVID if you get it.   :28

Cofrancesco says the best advice is to avoid all infectious diseases if possible, and if you already have HIV, to keep up to date on your medications to keep your viral count undetectable, since undetectable means you cannot transmit the infection to someone else. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: More people are reporting mental health problems as the pandemic rages on, Elizabeth Tracey reports

Mental health problems are spiking along with rising COVID-19 cases in many parts of the world, the Lancet reports. Eric Strain, a psychiatrist at Johns Hopkins, says he isn’t surprised.

Strain: I think it’s spot on correct. I think we’re seeing people who are very socially isolated and despondent. Because the responsible thing, they feel, is to stay at home, to be wearing a mask, to not be out in public, but we all need those experiences, to be out, to be seeing people, to have physical contact with other people. To hug a friend, to shake a hand. Those are things that carry some valence of meaning to us, which we now, if we’re being responsible, avoid doing.  :32

Strain says accessing tools such as Zoom and FaceTime can help, but that there’s no substitute for in person interaction. He recommends planning limited interactions with others and contacting a mental health expert if needed. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Data are mixed but concerns remain about school openings, Elizabeth Tracey reports

A reopened school in Israel has seen a wave of COVID infection after allowing kids to remove their masks, a recent report indicates. Yet studies of spread in households and the fact that kids are largely not as severely affected by COVID has empowered others to assert that schools should open. Aaron Milstone, a pediatric infectious disease expert at Johns Hopkins, comments.

Milstone: Although the risks of kids spreading it to each other may be perceived by some as low, because the complications of children may seem less risky than they are in adults, that is a little bit blind to the risks that those kids in school are imposing on their teachers and all the other staff at school that may have diabetes or other comorbidities that put them at increased risk for infection. I caution people in saying that children don’t play a role and its safe to send kids back to school because they’re not a driver of this infection.   :34

At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Emerging data suggest that COVID-19 infection is just as common in kids as in other age groups, Elizabeth Tracey reports

Kids and younger people in general seem to succumb to COVID-19 infection much less often than older people and those with other medical conditions, with a recent household study suggesting that parents usually brought the infection home. Yet Aaron Milstone, a pediatric infectious disease expert at Johns Hopkins, says observational studies are bearing fruit.

Milstone: As schools are starting to require testing before students return for sports they’re finding kids that are positive, that are asymptomatic, and we know that there are kids going to the beach and coming back that are positive. We have kids in the hospital that are positive. We know that kids have this virus. And we know that anyone who has this virus is at risk of spreading. So I would really caution people from thinking that kids are not playing a role in helping spread this virus. We can prepare for the fact that when schools go back that kids will play a big role in spreading.   :34

At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: What does following COVID infection in families tell us? Elizabeth Tracey reports

People other than children in a household appeared to develop COVID-19 infection first and transmit it to others, a recent found. Some interpret the study to mean that children don’t readily spread the infection. Not so fast, says Aaron Milstone, a pediatric infectious disease expert at Johns Hopkins.

Milstone: In fairness the study didn’t really comment on whether kids were a big driver or not. The study just described transmission dynamics within households. But there are lots of things we don’t know, which is kids got locked down pretty quickly, much more quickly than parents did. So I think that since parents were out going to work, parents were still interacting more and their kids were at home, so kids had less exposure and parents were then bringing it home to their kids. There’s also the observation as a parent that when you’re sick you still take care of your kids but when a kid is sick you put them in a room and you tell the other kids to stay away.  :30

Milstone says this study should not be used to inform decision making regarding opening schools, as the extent to which children communicate COVID-19 to others is not known. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: More trials to establish best practices for use of dexamethasone in different populations are needed, Elizabeth Tracey reports

A trial known as RECOVERY in the UK revealed the news that many people with severe COVID-19 infection could benefit from the steroid drug dexamethasone. Namandje Bumpus, director of pharmacology and molecular sciences at Johns Hopkins, says additional studies looking at the drug in specific populations are needed.

Bumpus: With dexamethasone there’s a lot more work to be done around understanding this drug response in populations. There’s not really anything known as far as differences in the Hispanic population. But as far as African Americans there are studies pointing to differences. There’s published work looking at black people that are asthmatic versus people that are non-asthmatic, basically showing that black people required more dexamethasone to get this activation effect you would expect from the drug.  :34

Bumpus says such studies are underway in the US. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Overdose deaths are increasing along with COVID-19 mortality, Elizabeth Tracey reports

Deaths from drug overdoses are reaching record levels even as those from COVID-19 continue to climb, CDC data reveal. Eric Strain, a drug abuse expert at Johns Hopkins, says there are many factors to consider.

Strain: Overdose deaths are up, and in some respects it seems like these death rates are getting obscured with the appropriate concerns about COVID. The overdose deaths are also concerning because we’re seeing more stimulant overdose deaths. So methamphetamine, cocaine. Those rates are going up. Now it may be that they’re combined with opioids but there’s some concern that we’re so focused on opioids that we’re missing the fact that methamphetamine use and cocaine use are going up as well.  :29

Strain asserts that many of these overdose deaths are likely deaths of despair, or intentional overdoses. He says that programs at Johns Hopkins and elsewhere are working hard to identify risk factors and barriers to treatment. I’m Elizabeth Tracey.