Health Topics – Johns Hopkins Medicine Podcasts

Anchor lead: What can a big data analysis of Covid-19 hospitalizations teach us? Elizabeth Tracey reports

Assessment of several clinical factors and other patient characteristics can predict who might have a severe course of Covid-19 when they are hospitalized, a study by Brian Garibaldi, a critical care medicine expert, and colleagues has shown. Garibaldi predicts the data analysis approach used here will reap many benefits beyond Covid-19.

Garibaldi: One of the longitudinal benefits is we’ve gotten together this group of really, really thoughtful biostatisticians, and clinical epidemiologists, who I think are going to be able to apply these methodologies beyond Covid to other diseases. That may be the most exciting piece about this work is not necessarily what happens with Covid but what we might be able to do to inform the interface between big data feeding back into the EHR to actually create real time decision support tools that work.  :29

Such an outcome would bring to fruition long held hopes for artificial intelligence and machine learning, Garibaldi says. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Can we predict the most likely outcomes for people hospitalized with Covid-19? Elizabeth Tracey reports

Using a number of factors assessed when someone comes to the hospital with Covid-19, it is possible to predict the likelihood of outcomes such as needing ICU level care, a study by Brian Garibaldi, a critical care medicine expert at Johns Hopkins, and colleagues has shown. Garibaldi says the study has additional implications.

Garibaldi: The other I think important message from this paper is that for those individuals who develop severe disease or death it can happen very quickly so the median time to developing that severe disease or that outcome was just over a day. What I think that suggests is that you have a very limited opportunity to both have these discussions with patients and their families to understand their preferences and their wishes but also suggests that there may be only a narrow window for us to do something for patients who are at high risk to try to prevent them from progressing to severe disease or death.  :30

Garibaldi hopes clinicians will use the data to help them plan in the event of further surges of Covid-19 at their facilities. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: There are ways to manage anxiety that are less risky than phenibut, Elizabeth Tracey reports

Phenibut is a sedative that’s being sold online as a supplement, and it’s increasingly involved in calls to poison control centers, ED visits and deaths, CDC data show. Eric Strain, a drug abuse expert and psychiatrist at Johns Hopkins, says if you’re feeling anxious there are other possibilities.

Strain: There are self help sorts of things that aren’t medication that people can find on the web, for difficulties with sleep or for managing low grade anxiety. You can search those and try those. You should also engage in a discussion with your primary care physician if you’re having sleep difficulties or you’re having anxiety that’s become a problem for you. There are medicines that are approved to help people sleep or to help deal with anxiety, especially if it’s become overwhelming.  :30

Strain notes that much is not known about phenibut, but most of the callers to poison control centers are in the 18-34 age range, three-quarters of whom were men. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: An online supplement called phenibut may not be your best choice if you’re feeling anxious, Elizabeth Tracey reports

Phenibut is a drug originally developed in Russia that’s used as a sedative, and it can be obtained legally online since it is sold as a supplement. Eric Strain, a drug abuse expert and psychiatrist at Johns Hopkins, says caveat emptor. Phenibut is chemically very similar to a class of prescription medications.

Strain: Benzodiazepines are medicines that are used for anxiety and sleep, and that seems to be where people are primarily using phenibut. I would not be surprised if people are trying if for those purposes but just like benzodiazepines I’d be very worried about medication interactions, using too much, and I don’t know, could people become dependent on it. It’s also important to make sure that there isn’t some other medical condition going on that might be causing a person to feel more anxious, or might be contributing to their sleep problems.  :32

The CDC has reported many more adverse events related to phenibut in recent months, including deaths. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: A supplement sold for anxiety should be avoided, Elizabeth Tracey reports

Phenibut is a drug legally sold as a supplement online that is resulting in many more calls to poison control centers, hospitalizations and deaths recently, data from the Centers for Disease Control and Prevention reveal. Eric Strain, a drug abuse expert and psychiatrist at Johns Hopkins, is alarmed.

Strain: Like anything that is untested I would be very cautious about using phenibut. I would be concerned about the purity and the source of it and the potential for interaction with other medications and for things like alcohol. It’s a GABA agent and GABA agents generally produce decreases in anxiety, it can be helpful for sleep, the big category of medicines that we think about when we think of GABA agents are benzodiazepines.  :30

GABA is short for gamma-aminobutyric acid, a chemical used by nerve cells to communicate with one another. At Johns Hopkins, I’m Elizabeth Tracey

Anchor lead: Even as we wait for a Covid-19 vaccine, the process of vaccine development has been vastly improved, Elizabeth Tracey reports

A given year’s flu vaccine has often not quite matched the strains of the virus circulating, due to the time needed to make the vaccine and other constraints. Now Andrew Pekosz, a vaccine expert at Johns Hopkins, says those days may be behind us with lessons learned from the development of Sars-CoV2 vaccines.

Pekosz: The time line for moving a vaccine through testing into real world vaccination campaigns can be shortened without a compromise in terms of safety. If that’s one lasting legacy of this pandemic it would really be tremendous because there’s so many vaccines that are mired in the moving through the phase one, two three process. So many companies just don’t want to move forward with new vaccine formulations because they’re essentially being told they have to work through this 15 year process.  :30

Pekosz says a more nimble vaccine development and manufacturing process will also allow the system to respond rapidly as new viruses and different strains of old ones emerge. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Different age groups will need different Covid-19 vaccines, Elizabeth Tracey reports

Did you know that children, adults, and elderly people all receive flu vaccines based on their age and immune response? The same is very likely to be needed when it comes to a Sars-CoV2 vaccine, says Andrew Pekosz, a vaccine expert at Johns Hopkins. And that may stymy current vaccine front runners.

Pekosz: Just because you’re first to cross the line doesn’t always mean that you’re the best. Because it’s quite possible that some of the ones that are still just entering phase three trials, may actually have better efficacy. The other thing that’s important for us to understand is oftentimes we think of a vaccine as one size fits all. We have to understand that immunizing  children is different from immunizing adults is different from immunizing the elderly. Each of those age groups has a very different response to infection and a very different disease progression.   :33

Pekosz says even the need for more than one shot for sufficient immunity may vary according to age. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Can a mixture of antibodies help our bodies respond to Sars-CoV2? Elizabeth Tracey reports

Engineered viruses form the backbone of a few of the Covid-19 vaccines being used and tested around the world, and these vaccines stimulate our bodies to make a range of antibodies against the virus, while some other vaccines rely solely on a single antibody. Andrew Pekosz, a vaccine expert at Johns Hopkins, says this may turn out to be the more antibodies, the better.

Pekosz: Everybody is focused now on these neutralizing antibodies because that’s the best correlate of protection we have with other coronaviruses as well as with other viruses in general. Those neutralizing antibodies bind to one very specific part of the spike protein, and they primarily work by preventing the spike protein from attaching to infect cells. Are some of those other antibodies, that bind to other areas of the spike protein, do they do something in terms of helping the immune response, in the body?  :30

Pekosz notes that only when these vaccines are widely administered will we know if one strategy is best. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Could some vaccines prompt a broader immune response? Elizabeth Tracey reports

Sars-CoV2 vaccines all attempt to stimulate the body to produce antibodies against the virus’s spike protein, used to infect our cells. Yet Andrew Pekosz, a vaccine expert at Johns Hopkins, says some of the vaccines being tested also elicit other responses.

Pekosz: We always focus on antibodies. What we don’t think a lot about is the role of T cells in protection. T cells do lots of different things but in the simplest way when it comes to a Sars-CoV2 vaccine, there are these T helper cells  which help your B cells make antibodies. There’s a lot of data out there right now suggesting that people who are exposed to common cold coronaviruses may have some T cells that actually cross react with Sars coronavirus 2. We may be able to tap into some level of pre-existing immunity and enhance that a bit to get up broader protection against Sars-CoV2.   :33

Pekosz notes that while antibodies may wane over time, the T cells remain capable of responding to the virus. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: There are still many steps to getting a Covid-19 vaccine to market, Elizabeth Tracey reports

At least three vaccines against Sars-CoV2 are in later stage clinical trials domestically, with another just entering this phase. Andrew Pekosz, a vaccine expert at Johns Hopkins, says there’s no way to speed up the process.

Pekosz: These phase three trials just take time. Because you’re double-checking safety, you’re double-checking, in the case of a vaccine, what’s called immunogenicity, which is does the vaccine induce some sort of an immune response, and that immune response differs based upon the kind of vaccine you’re using, but the thing about phase three trials is it measures efficacy, so it actually goes out there and says, I’ve got a group here that’s been vaccinated, I’ve got a group here that’s been sham vaccinated, and we have less disease in our vaccinated group than in our sham group.  :30

Pekosz says exposure and potential infection with Sars-CoV2 is taking place naturally after a volunteer has been vaccinated, although in the UK there is consideration of exposing vaccinated volunteers to the virus to see if they are immune. At Johns Hopkins, I’m Elizabeth Tracey.