Health Topics – Johns Hopkins Medicine Podcasts

Variants of Covid are springing up all the time, perhaps in people who have compromised immune systems and experience prolonged infection or in animal hosts. Stuart Ray, an infectious disease expert at Johns Hopkins, says right now with Delta and Omicron variants circulating, vaccination is more crucial than ever.

Ray: The people who are really unvaccinated and not immune may be particularly susceptible to Delta. And some of the severity we’re seeing may be in that population, so there’s still the situation where you don’t want to be the last person who has no armor. Getting vaccinated is a smart thing to do if you’re not at all vaccinated yet, and following the current recommendations is the safest  way to get immune, but we may see variants that surprise us, because the fitness landscape is shifting, and the rules are changing  for the virus as well as the rest of us.  :28

Ray agrees with many in the field that modified Covid vaccines, many already in development and testing, may be necessary as new variants continue to emerge. At Johns Hopkins, I’m Elizabeth Tracey.

Both vaccine developers and the FDA have agreed that as new Covid variants emerge and updated vaccines are required, the pathway for providing them should involve testing in far fewer people and over a shorter period of time. Jonathan Zenilman, an infectious disease expert at Johns Hopkins, applauds the effort.

Zenilman: With different variants the FDA has agreed that that would be a reasonable pathway. The challenge is timing. Think about if we were going to develop and field an Omicron  vaccine the simple logistics of production and distribution would take three months at a minimum, so we wouldn’t have  it out until April, and think that Omicron has only been with us for less than three months so I think part of this becomes a predicting game very similar to what we do with the flu and I think that’s what we’re going to see moving forward.  :30

Flu vaccines are updated yearly based on which strains of the flu are circulating in Asia and surrounding countries. The promise of mRNA vaccines should extend to them also to make better matches each year. At Johns Hopkins, I’m Elizabeth Tracey.

Why aren’t Covid vaccines, especially mRNA vaccines, being produced against variants such as Omicron as they emerge? Anna Durbin, an infectious disease expert at Johns Hopkins, says this is what the technology promises.

Durbin: I do think we have to be more forward thinking and also working with regulators because if we could get very fast approval of second, third generation, which we should be able to based on the way we get approval for influenza vaccines and the way this technology works. It’s not a difference in manufacturing it’s just a difference in the genetic sequence of the vaccine. I think that would be very helpful but I think eventually we’re going to have to move to a different sequence of vaccine particularly if we’re seeing more divergence even beyond Omicron.  :32

Durbin and other vaccine experts agree that modification of vaccines is very likely to be ongoing as new variants are also likely to continue to emerge. At Johns Hopkins, I’m Elizabeth Tracey.

If you’ve had three doses of an mRNA vaccine against Covid you are much less likely to require hospitalization, require ICU level care, or die from Covid-19, even with the now dominant Omicron variant, than if you aren’t vaccinated at all. Anna Durbin, an infectious disease expert at Johns Hopkins, explains.

Durbin: With Omicron the mutations make it more of an escape. The antibodies prevent infection and its incredibly difficult for any vaccine to prevent a respiratory infection, so it’s not surprising that we’re seeing far less efficacy against infection with Omicron and that we’re seeing more disease and I think what’s really important to note is that we still see some good protection against severe disease even in those who have not been boosted yet.  :31

Durbin notes that those who are eligible for their third dose should get it as soon as possible. At Johns Hopkins, I’m Elizabeth Tracey.

Children younger than five comprise the last group in whom a vaccine against Covid is currently being tested. Jonathan Zenilman, an infectious disease expert at Johns Hopkins, says late spring may be when enough data will be in for an emergency use authorization.

Zenilman: It turns out probably because of Omicron cause this is now going on in the middle of a surge, they may have enough cases to show efficacy as well. Under the optimistic progressions we may have data for a small kids vaccine, 6 months to 4 years, by mid-April, early May but that’s going to be a three dose series. And I think all of us who are in this recognize that the primary series even for the adult vaccine is probably a three dose series anyway, which is why they decided to go that way.  :32

Zenilman notes that data from other age groups seems to show that three doses with appropriate spacing are necessary for the best response. At Johns Hopkins, I’m Elizabeth Tracey.

First responders and frontline workers have largely soldiered on during these last two years as covid continues to morph. Karen Swartz, a psychiatrist at Johns Hopkins, says when that pressure it released there could be a big impact.

Swartz: My concern is, as we finally emerge from the Covid infectious disease disaster that for the first time many will be experiencing a sense of being overwhelmed, and be able to actually feel their depressive symptoms or anxiety symptoms. I have particular concerns for those who are on the front lines: first responders, healthcare workers, delivery teams and those keeping essential production moving, who have never really had rest during this long challenging period. Some may even experience PTSD because of traumatic experiences they had during this pandemic, working on the front lines.  :32

Swartz reminds those in these positions to pay attention to how they are feeling, as PTSD in particular responds well to intervention, and the sooner the better. At Johns Hopkins, I’m Elizabeth Tracey.

One in three adults is reporting mental health problems as the pandemic continues, the most recent CDC data indicate. Karen Swartz, a psychiatrist at Johns Hopkins, says anxiety is extremely common, and depression is hard on its heels.

Swartz: With depression they’ll describe feeling much more negative about themselves and about the future. They also have significant distress. Their capacity to feel joy is blunted, and they have feelings of sadness or irritability or a lack of feeling. Most often they also have changes in sleep, appetite, energy and focus. During the pandemic there’s been a clear pattern, where younger individuals seem to be having more anxiety and depressive symptoms compared to older individuals. Younger adults, say in the 18 to 30 range, report much higher rates of anxiety and depressive symptoms, than those who are older.  :33

Swartz says treatment is especially important for this young group as depression is well known to recur and can become more severe. At Johns Hopkins, I’m Elizabeth Tracey.

How can you tell if you or someone you love is developing anxiety as a result of the pandemic? Karen Swartz, a psychiatrist at Johns Hopkins, describes the most common characteristics.

Swartz: With anxiety, an individual has a level of distress that often interferes with functioning. They have ongoing tension, and have negative thoughts that are spinning in their mind. They feel off, often with increased heart rate, or trouble catching their breath, and their stomach can feel upset. Anxious people can get into the habit of avoiding activities that make them nervous to make them feel comfortable. And this often leads to someone significantly restricting their activities or even having disability. They also have an ongoing feeling that things aren’t right, and that bad things are likely to happen.  :31

Swartz says the good news is anxiety can be managed. A number of different psychotherapeutic techniques and a variety of medications, either alone or in combination, will usually be effective. She notes that developing a trusting relationship with a therapist is key. At Johns Hopkins, I’m Elizabeth Tracey.

You’ve seen them- the people who continue going about their daily business, cheerfully unfazed by the omicron craziness. Then there are others, furtively visiting the grocery store at 4am to reduce their risk of infection. Karen Swartz, a psychiatrist at Johns Hopkins, says she’s observed almost everyone falling into one of three groups.

Swartz: I believe there are three groups of people. The first is surprisingly resilient. The second is understandably exhausted, and the third is concerningly vulnerable. The rates of reported anxiety and depressive symptoms quadrupled in the summer of 2020, compared to the baseline rates of the summer of 2019. The rates of depression and anxiety symptoms remain three times higher than the baseline rates prior to the pandemic, and the recent CDC data, thirty percent of adults reported having significant anxiety or depressive symptoms.   :31

Swartz says transitions between groups are possible, and if you’re one of the vulnerable group seeking help may be your best course, especially if you feel things are getting worse. At Johns Hopkins, I’m Elizabeth Tracey.

The beat just seems to go on and on with Covid and the Omicron spike. Karen Swartz, a psychiatrist at Johns Hopkins, says what we all need is a dose of resilience, and oh so fortunately, we can help ourselves develop this quality by practicing gratitude and other strategies.

Swartz: Another very effective practice for improving resilience is using a variety of relaxation techniques, including doing progressive muscle relaxation, yoga, meditation, mindfulness training, and exercise.  Mindfulness training is something that with practice we can all do effectively. There are also a number of apps or programs available online to help people develop their own mindfulness practice. All of these mindfulness relaxation techniques focus on positive activities and doing things that reduce our level of stress and distress.   :30

Swartz notes that the most recent CDC data indicate that many of us are experiencing mental health challenges in large part because of the pandemic, so cultivating resilience is especially important right now. At Johns Hopkins, I’m Elizabeth Tracey.