Health Topics – Johns Hopkins Medicine Podcasts

Anchor lead: Research nurses underpin the success of the RECOVERY trial, Elizabeth Tracey reports

RECOVERY is the acronym for a large randomized clinical trial taking place in the UK to evaluate treatments for Covid-19 quickly, and it has been credited with early identification of dexamethasone for helping those on ventilators. Now study leaders say among the critical factors for their success are research nurses. Patricia Davidson, dean of the Johns Hopkins School of Nursing, isn’t surprised.

Davidson: Not only do you as a nurse bring your clinical skills and attributes to the trial, the nurses have a big role in making sure that people are retained on the trial, that they are adherent with the medication, and also that data is collected on all the important endpoints for analysis. Because as we know a randomized controlled trial, if 30% of the people are lost to follow up, or other things, the data are pretty meaningless.  :32

Davidson says a research career is just one of the many options open to nurses. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Should testing for Covid-19 occur more or less often? Elizabeth Tracey reports

Fewer people should be tested for Covid-19, federal officials stated recently. Aaron Milstone, an infectious disease expert at Johns Hopkins, says there really are two sides to this argument over testing.

Milstone: Some people believe that the sooner you identify someone that the more they’ll take it seriously. The other argument is if you’re exposed and we test you and you’re negative, then you’re not going to take it seriously and people will think I don’t have Covid and I can go to my friend’s house and they may ignore those quarantine recommendations. I do see that there are two clear sides to this. There may be value in recommending testing for people who are asymptomatic yet exposed to Covid but there may be an unintended harm in that in giving people false reassurance that they are clear and free.  :34

Milstone notes that the picture is further complicated by the fact that some tests are not very accurate so may give an untrustworthy result, and says over time, greater reliability will be developed. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Allowing pharmacists to administer vaccines to kids will expand access, Elizabeth Tracey reports

Pharmacists are now allowed to give vaccines to most children, the federal government has mandated. Aaron Milstone, a pediatric infectious disease expert at Johns Hopkins, says especially now, that should enable many more children to obtain needed vaccinations.

Milstone: Increasing access to vaccines is great for children. Doing it safely is also important. As long as pharmacists are prepared for reactions that either kids or adults can have, then I think increasing the access to vaccines is a positive thing. Any concern I have would be way overpowered by the benefits of increasing access to vaccination. I think having a vaccine registry really will facilitate good communication and record keeping about places like pharmacies giving vaccines. :32

Milstone notes that parents should likely keep their own record of their children’s vaccinations as well as assure that their child’s medical home is also informed. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Children may have very high levels of Sars-CoV2, Elizabeth Tracey reports

Some children have higher levels of Sars-CoV2 in their airways than even severely ill adults, a recent Pediatrics study found. Aaron Milstone, a pediatric infectious disease expert at Johns Hopkins, comments.

Milstone: None of us are surprised that kids are a potential reservoir for spreading respiratory viruses. We know that from flu, other studies have also shown increased viral loads in children. Having a high viral load doesn’t mean that you’re at risk of spreading than having a low viral load. When an adult coughs in your face they might do that with more force than a child, or they might be closer to your face than a child, so having that high viral load in a kid if they’re farther from you or generating lots of force may put you at less risk. But whether or not you’re more likely to get it from a kid or an adult still remains unclear.  :33

Milstone says as facts emerge about viral spread, one strategy is helpful: act as if everyone you come in contact with is infected, and make choices accordingly, including mask wearing, hand washing, and physical distancing. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Where Sars-CoV2 enters the body should be covered by a mask, Elizabeth Tracey reports

Many more receptors for Sars-CoV2 are found in the part of the nose where smell takes place than elsewhere, research by Andrew Lane, an otolaryngologist at Johns Hopkins and colleagues has shown, and it may be that’s the primary place the virus infects us. Lane says that has clear implications for mask-wearing.

Lane: If the virus does in fact start in the nose or end up in the nose or that’s a place where even if you had no other symptoms that the virus might be located, it makes sense that when you breath out through your nose you maybe could potentially be spreading the virus. So therefore more for other people not necessarily for you you need to cover your nose and not just your mouth to prevent spread. And that’s the way to wear a mask anyway it’s not as though this is some new way to wear a mask. The proper way to wear a mask is to cover your nose and your mouth.    :25

So if you’re one of those people who sling your mask under your nose reconsidering this practice would most likely help others. Lane notes that with the plethora of masks of varying materials available, finding one that is comfortable and covers both nose and mouth should be straightforward. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Can smell changes be explained by Sars-CoV2 infecting that area of the nose? Elizabeth Tracey reports

We all have proteins on the surface of cells in our bodies known as receptors, and one of them, abbreviated ACE2, is used by Sars-CoV2 to infect us. Now research by Andrew Lane, an otolaryngologist at Johns Hopkins, and colleagues, has shown that the area in our nose involved in the sense of smell has several hundred times more ACE2 than other areas of the nose.

Lane: Well if that’s really true could you direct a therapy towards the olfactory epithelium and try to nip it in the bud? The other angle is if it really is there in a lot of people who are otherwise asymptomatic would it be possible as a screening tool to study the olfactory system. Maybe some simple test might catch some proportion of people who have olfactory dysfunction but not olfactory loss, it may be a more subtle change in their sense of smell that might indicate they’re infected.  :25

Lane notes that some researchers have developed a scratch and sniff card to help screen people who may have very minor changes in their sense of smell, and that might point toward those capable of spreading the virus even though they have no other symptoms. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Tissue in your nose may be the first site Sars-CoV2 binds to, Elizabeth Tracey reports

ACE2 is the acronym for the site on cells Sars-CoV2 uses to bind and then infect them. Now research by Andrew Lane, an otolaryngologist at Johns Hopkins, and colleagues, has shown that the very specific area of the nose where cells responsible for the sensation of smell reside – called the olfactory epithelium -  may also be where the coronavirus goes first.

Lane: We did staining to find the location of this ACE2 protein. We were surprised to see it was hundreds-fold, somewhere between 200 and 700 times more expressed on the part of the cell facing outwards into the environment. That’s where all this ACE2 is, so it gives you a possible explanation for why the olfactory system might be a particular target of this virus. When we test for this virus we always test people’s nose because the other places you could sample like saliva or other bodily fluids don’t contain very much virus. The money’s always in the nasopharyngeal swab.   :31

Lane says the next step is to take living tissue to see if the virus prefers this area. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How do attitudes toward condoms impact on their use among teens? Elizabeth Tracey reports

Sexually active teens don’t just need to prevent pregnancy, they also must avoid a host of increasingly common sexually transmitted infections, and that means using condoms. Yet a CDC study demonstrates that fewer than one in ten do so. Maria Trent, director of adolescent medicine at Johns Hopkins, comments.

Trent: We still have a condom problem. It’s kind of like mask wearing. It’s like a protective barrier. When do you wear it and when do you not? And what we’ve seen is that oftentimes people struggle with doing what is good for them from a public health perspective. We have to continue to encourage adolescents, provide positive messages around condom use, even when people may have long acting contraception, even when people may be on pre-exposure prophylaxis for HIV we have to continue to use condoms to prevent the everyday STDs that can truly disrupt their lives.   :31

Trent notes that some sexually transmitted infections are incurable or may have dire health consequences if they go untreated. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How has the pandemic complicated rates of sexually transmitted infections among teens? Elizabeth Tracey reports

While one-quarter of a nationally representative sample of teenagers said they were sexually active, fewer than one in ten said they used condoms while having sex, a CDC study finds. Maria Trent, director of adolescent medicine at Johns Hopkins, says the pandemic has complicated this issue for parents.

Trent: We still have to do the hard work of preparing them to make good decisions when they’re not with us, and that means we have to talk about sex, talk about condoms. For some people condoms may seem like a luxury. And so I think we have to really think about preparing young people to have what they need, but also to think about parents who may be struggling now, how are they going to give them those resources? I think it may be hard for families to purchase the supplies now.   :25

Trent notes that just like pediatrics practices, those that focus on adolescents also recognize and integrate the central role families play in their health. She urges parents to identify their needs and ask for help from their children’s providers, as they are often an excellent source for referral. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: A very low percentage of sexually active teens use protection, Elizabeth Tracey reports

Fewer than one in ten sexually active teenagers use recommended protection, a Centers for Disease Control and Prevention study finds. Maria Trent, head of adolescent medicine at Johns Hopkins, says the current pandemic has made the situation worse.

Trent: We’re also not screening people during this time of Covid, which further exacerbates the problem that we might see in young people who are particularly at risk, those who are fifteen to twenty-five are at most risk. We need to start thinking about how we are going to address other infectious diseases, even during the Covid pandemic, even when its over, I think we’re going to have to have a plan for how we’re going to take care of patients, to screen people for STDs, to get them treated, to get their partners treated, we really are going to have to work on that.   :29

Trent says barriers to teens coming into clinics for testing and treatment are higher now than ever, and worries that for some young women, the complications of untreated STIs may include infertility down the road. At Johns Hopkins, I’m Elizabeth Tracey.