Health Topics – Johns Hopkins Medicine Podcasts

Kids are back in school in person now in many parts of the United States and the world, yet both they and their parents are still worried about activities and contagion risk, especially in children younger than 12 years of age and others not yet vaccinated. Aaron Milstone, a pediatric infectious disease expert at Johns Hopkins, offers some words of encouragement.

Milstone: Kids are frustrated because they feel that things are being taken away from them. And I keep telling parents that parents are creative and resilient and we can find fun things for our kids to do, even in this pandemic. And we did that last year. So even in this fourth wave, even as we go through the winter, I mean parents really need to set a positive tone for their kids and say we can find fun and safe things for you to do. Put your mask on, get your vaccine, and if we’re smart we can continue to let kids enjoy the kind of day to day stuff and going back to school.  :28

Milstone says preparation is everything, including providing masks and backups to kids, helping kids strategize on ways to stay safe even if they’re among unmasked people, and being reassuring. At Johns Hopkins, I’m Elizabeth Tracey.

Antibodies donated by people who’ve recovered from COVID infection, known as convalescent plasma, is a therapy that does have emergency use authorization by the FDA, and that must be given to hospitalized people early in the course of infection. Arturo Casadevall, a convalescent plasma expert at Johns Hopkins, says timing is critical.

Casadevall: It is important to know that there is a therapy that the FDA has on its emergency use authorization that has been underused. Patients it would great if they had a discussion with their physician. And it would be great if the physicians who admitted them to the hospital took the time to familiarize themselves as to what the available data is. It is mixed, we are the first ones to admit it. But that has to be taken in the view that it is relatively safe, the evidence is that if it is used early that is where the studies are showing the efficacy in reducing mortality. :33

Casadevall says people who are admitted to the hospital should ask their physicians if they are candidates for this therapy, which he says helps many avoid severe COVID. At Johns Hopkins, I’m Elizabeth Tracey.

A treatment known as convalescent plasma, which is basically antibodies from someone who’s already recovered from COVID, can help in early COVID infection, but the caveat is early. Arturo Casadevall, a convalescent plasma expert at Johns Hopkins, says for people with certain health conditions, seeking early treatment is a wise idea.

Casadevall: The public needs to know that there are therapies available that work best if you seek early care. So if one is diabetic, if one has hypertension, if one has lung disease, it’s better to seek help when you have symptoms than to wait until you call EMS to come bring you in. Doctors in the emergency room, plasma can only be given to hospitalized patients, so once you make that decision to admit, that is the time to give them plasma.  :29

Casadevall and colleagues have recently linked increased rates of death due to COVID to reduced use of convalescent plasma, a treatment he calles largely safe and cost-effective. He hopes people will ask their physicians about it. At Johns Hopkins, I’m Elizabeth Tracey.

Antibodies in the blood of people who’ve had COVID and recovered can help others avoid severe cases of the disease, use of this treatment in some has shown. Yet when larger scale clinical trials were undertaken, results were largely lackluster, and the treatment has fallen by the wayside. Arturo Casadevall, a convalescent plasma expert at Johns Hopkins, reflects on why results were mixed.

Casadevall: Last year there was a lot of excitement for convalescent plasma, half a million people got treated. Then came some really poorly designed clinical trials. People were treated very late. Well, if you do a trial and it didn’t work because you set it up not to work then plasma doesn’t work. And then what happened is there was a reduction in use. We were able to document that as the use went down more people died.  :26

Casadevall says convalescent plasma is a viable treatment for COVID infection, and he’s trying to make both physicians and patients aware of the need to use it early in the infection to maximize its benefits. At Johns Hopkins, I’m Elizabeth Tracey.

Convalescent plasma is plasma donated by people who’ve already had COVID and recovered. Early in the pandemic this historically successful technique was attempted to stem the tide of COVID-related death, but now the therapy has fallen into disuse. Arturo Casadevall, a convalescent plasma expert at Johns Hopkins, explains.

Casadevall: We are talking about a therapy that is given once that costs $300.00. What is the risk benefit of this? And people are not using it. This therapy works best when given early. COVID has two phases, a viral phase and an inflammatory phase. The inflammatory phase is what puts you in the hospital. That’s because it interferes with gas exchange, people get short of breath. The antibody works on the viral phase, so many people when they show up in the emergency room are already too late to be helped. But not all of them are that late.   :30

Casadevall is trying to raise awareness of convalescent plasma therapy, which he says could benefit many and reduce the need for hospitalizations nationally. At Johns Hopkins, I’m Elizabeth Tracey.

Remote monitoring helps people undergoing treatment for cancer cope better with emerging symptoms, a new study concludes. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says this strategy may be even more important as new cancer treatments are developed.

Nelson: One of the things about chemotherapy is we sort of have a good sense when people get into trouble with nausea and vomiting, when people get into trouble with an increased risk for infection. When we look at some of the new immunotherapy agents people can get in trouble with activating the immune system attacking some normal part of the body. They’re a little bit less predictable but it’s very clear if the early symptoms are captured and it prompts an intervention that you can stop this autoimmune attack and not compromise the benefit of the immunotherapies.  :30

Nelson says data from remote monitoring can be integrated into electronic medical records so it is instantly available for care teams to respond. At Johns Hopkins, I’m Elizabeth Tracey.

People who used a remote monitoring tool to report daily symptoms as they underwent cancer treatment did better with regard to managing their treatment than those who did not, a new study finds. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, isn’t surprised.

Nelson: What they were looking at were symptoms that people started with and symptoms that they would acquire as they are being treated with chemotherapy and radiation therapy and the like, is monitoring this basically at home 24 hour monitoring with one of these tools, can they identify symptoms and intercept them in some way so that they could be better managed. The answer was yes. When they did this kind of monitoring, when you looked at the folks who did the monitoring they didn’t get that much more and the more would have been related to the treatment and so managing the treatment associated symptoms with this monitoring tool seemed to be helpful.  :32

Nelson says people also like participating in their own care and felt more in partnership with their medical team. At Johns Hopkins, I’m Elizabeth Tracey.

People who are 75 and older and otherwise healthy reap benefits from continuing colorectal cancer screening, a new study found. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says that with new fecal screening tests, such a strategy makes even more sense.

Nelson: I think for the time being I think what is going to happen pretty quickly is that in this particular dataset they were not able to look back and make significant comments on the DNA containing stool tests. The Cologuard, that’s FDA approved, there’s other ones coming I think. And how often should you have that? Would that be a reasonable strategy to even more fine tune who gets colonoscopy who doesn’t when you get older. I think there’s going to be a lot more to be said about this and it’s going to be in the favor of there are people above the age of 75 who need to be screened.  :31

Nelson notes that this issue of age and cancer screening in general is actively being investigated by many, as is how best to treat older adults with cancer. At Johns Hopkins, I’m Elizabeth Tracey.

Colorectal cancer screening is recommended to begin at age 45, but at what age should it end? A new study finds that even in many over the age of 75, screening can still be beneficial. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, explains.

Nelson: This study looks at what should we do with people when they get over the age of 75. They used data from the Nurses Health Study and the Health Professional Follow up Study and there was a clear advantage to screening after the age of 75. Whether you’d been screened before age 75 or not. The real reason you might think about not doing so much screening is related to the jargon term is competing causes of mortality, in other words if you have somebody who’s in an intensive care unit because their heart doesn’t work very well screening them for colorectal cancer not likely to be helpful.  :33

Nelson says that continuing screening or not should be a topic for discussion with your primary care physician. At Johns Hopkins, I’m Elizabeth Tracey.

Rates of diabetes are increasing, recent data indicate, and factors related to the pandemic seem likely to be related. Rita Kalyani, a diabetes expert at Johns Hopkins, describes some of them.

Kalyani: As we see less face to face interaction during the pandemic, less attention to healthy lifestyle behaviors, for good reason in many cases, fear of being outside, fear of going to the gym, all the things that we hear about. But we are going to see maybe a spike in the prevalence of these risk factors because during the pandemic people just weren’t able to follow the same routines as they were pre-pandemic. In some ways we might expect it’s going to take us back a little bit.  :29

The pandemic has also compromised how well clinicians can manage different aspects of diabetes care, which some are calling ‘treatment stagnation.’ For now, Kalyani says those with diabetes must redouble their efforts to keep the condition under control and become as educated as possible about the disease. At Johns Hopkins, I’m Elizabeth Tracey.