Health Topics – Johns Hopkins Medicine Podcasts

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.

Anchor lead: How should we approach helping people with opioid use disorder? Elizabeth Tracey reports

Substance use disorders are causing an epidemic parallel to Covid-19, with over 80,000 deaths reported over the one year period ending in May 2020, according to the CDC. Eric Strain, a substance use disorders expert at Johns Hopkins, says we must revamp our entire approach to helping people overcome this problem.

Strain: We talk about patient centered care, but then we say what you should want is to be on buprenorphine, or maybe naltrexone. We need to better understand what do they want that they think would be helpful to them? What are the social factors that are impacting? How are we addressing those? And what are the things that drive them to find meaning and purpose in their lives? We should not be saying here’s a buprenorphine prescription, now you’re better. We need to understand what is it that will make them have more meaning, more purpose. How will they flourish in their lives?  :34

Strain says such an approach will require a treatment team as well as social supports and policy changes. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How many deaths due to opioid use disorder are suicides? Elizabeth Tracey reports

During the one year period from May 2019 to May 2020, 81,000 people died of drug overdoses, CDC data reveal. That number is almost certainly an underestimate, and is almost twice as high as the previous year’s data. Eric Strain, a substance use disorder expert at Johns Hopkins, says this high rate most likely includes quite a few suicides, or deaths of despair.

Strain: I think that there could be people who are demoralized, with all that’s going on socially. The isolation, depression, unemployment, economic uncertainty, housing uncertainty, there’s a lot of factors going on right now. Just like the general population is stressed I think this population is stressed as well. But this is a population that turns to using opioids at times when they’re stressed.  :25

Strain says these dire numbers call for increased vigilance on everyone’s part, as well as removal of barriers to treatment. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: In addition to Covid-19, overdose deaths are skyrocketing, Elizabeth Tracey reports

From May 2019 to May 2020, deaths due to opioid overdose were almost twice as high as the previous year, Centers for Disease Control and Prevention data indicate. Eric Strain, a psychiatrist and substance use disorder expert at Johns Hopkins, says even that number is most likely an underestimate.

Strain: I think previously the latest data were through 2018 but they announced this data through May of 2020. And it was 81,000 overdose deaths for that 12 month period. In 2018 I think we had something on the order of 46,000. Part of what’s striking about this is some of us thought that with Covid we might see a decrease in deaths because people were socially isolating and may not be out purchasing fentanyl and things like that and if anything its been the reverse.  :31

Strain says the numbers clearly point to an urgent need for intervention, and notes that all stakeholders need to be involved, including patients, clinicians and policymakers. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Does limiting your eating to just six hours a day result in weight loss? Elizabeth Tracey reports

Confining food consumption to just six hours a day will help you lose weight and keep it under control, advocates say. Yet a study by Nisa Maruthur and colleagues at Johns Hopkins, which provided food to participants and allowed one group to eat as they usually did, while the other ate earlier in the day and over fewer total hours, did not demonstrate a difference between the two groups.

Maruthur: Our study shows that its probably still about calories in calories out. So if restricting your window helps you to restrict that that’s probably good. And then the other thing we’ve known about dietary patterns and trying to improve lifestyles is that you have to do something that works for you. And so if eating between twelve and six is not going to make your miserable and it works for you then that’s the other thing that’s really important. That’s what we’ve seen with all the studies of different dietary patterns is that any dietary pattern can be healthy; it has to be one you can follow.  :27

Maruther notes that being mindful of other personal habits such as sleep and  and integrating them with eating behaviors may also be important. At Johns Hopkins, I’m Elizabeth Tracey.