Health Topics – Johns Hopkins Medicine Podcasts

Anchor lead: Do we need to be concerned about more Sars-CoV2 transmission this fall in the Northern hemisphere? Elizabeth Tracey reports

As the pandemic began in the much of the world this spring, cooler temperatures have emerged as one factor leading to higher rates of transmission of Sars-CoV2, according to research by Adam Kaplin, a researcher and psychiatrist at Johns Hopkins, and colleagues. Kaplin says temperature alone isn’t the whole picture.

Kaplin: It’s not all one thing or another but what I think it’s saying is that if you currently are in a place where your social intervention has you at this stable place, as it gets cooler it’s not going to be enough. It’s going to start to take off. So we know that when we stop the social interventions it has begun to go up again, but the rate at which it is going up I think it going to increase as it gets cooler. :30

Kaplin says renewed emphasis on avoiding crowds and use of masks is at minimum a prudent strategy to avoid infection. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How important is outdoor temperature in the spread of Sars-CoV2? Elizabeth Tracey reports

Factors associated with increased rates of transmission of Sars-CoV2 include increased population density, younger age of the population, and cooler outdoor temperatures. That’s according to a study by Adam Kaplin, a researcher and psychiatrist at Johns Hopkins and colleagues.

Kaplin: As the temperature went up the rate of transmission went down, I can also say that even though it was going up where it was cooler the rate of transmission was much faster, even though yes, it was going in the up direction the cooler it was the faster the transmission and we know from all the respiratory viruses that have temperature sensitivity, when the rate goes down when it gets warmer it goes up when it gets cold.   :28

Kaplin’s concern is that as the Northern hemisphere moves into fall and winter, the temperature variable may become more important in the transmission of Sars-CoV2  At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: What do fall temperatures portend for Covid-19? Elizabeth Tracey reports

Cooler temperatures during the spring of 2020 were associated with faster transmission of Sars-CoV2, a study by Adam Kaplin, a researcher and psychiatrist at Johns Hopkins, and colleagues has shown. Kaplin describes the findings.

Kaplin: What we showed was that as the temperature was increasing going from January to April in these fifty countries in the Northern hemisphere our data says the higher the temperature the slower the increase in transmission,  early on when its still kind of linear, and before you have social interventions. But once you begin to take off, you get the social variables involved and then it’s no longer looking at just the temperature.  :32

Kaplin says interventions such as physical distancing, closure of schools and indoor gathering spaces, and wearing of masks then overcame the impact of temperature in transmission. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: An orthodontist may be the first specialist for an infant with cleft lip/palate, Elizabeth Tracey reports

Infants born with cleft lip and/or palate can benefit greatly by early intervention from an orthodontist, the team at Johns Hopkins has found. Ilana Ickow, a Hopkins orthodontist who specializes in treatment of babies with the conditions, describes first steps.

Ickow: When a baby is born with cleft lip and palate a process called nasoalveolar molding or NAM for short is done and an appliance that looks like a retainer is used to make the gum segments in the mouth closer together. It also moves the lip segments closer together. This process is started within the first few days of life and can last three to six months depending on the severity of the cleft. The goal is to give the mouth and the nose a more normal anatomy, to give the surgeon a better starting point for surgery.   :30

Ickow says babies are also fed with a special bottle during this time. She notes that using the appliance also helps both mouth and nose achieve a more symmetrical position. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Diagnosing cleft lip and palate using ultrasound has advantages, Elizabeth Tracey reports

Cleft lip and/or palate is very common, occurring in about one in 700 to one in a thousand babies born with condition in the US each year. Jordan Steinberg, a plastic surgeon at Johns Hopkins who specializes in treating these children, says early identification helps.

Steinberg: Today we have very good success even at the screening 20 week ultrasound for pregnant moms, if a cleft lip and/or palate is identified we try to set them with a visit right around that time period with our team to help get some information about what may be ahead. Many families really benefit from that experience because of the preparedness that they can gain prior to the birth of their child. Some of the things that we concentrate on are feeding, we will meet with the orthodontist, then we transition into a discussion about what are the major surgical milestones during that first year of life.  :35

Steinberg says the team at Hopkins takes a comprehensive approach to treatment since the condition impacts many aspects of life, such as feeding and speech. I’m Elizabeth Tracey.

Anchor lead: Surviving hospitalization with Covid-19 may be just the beginning of recovery, Elizabeth Tracey reports

Among the many conditions that can develop once someone is discharged from the hospital after Covid-19 are mental health problems. Adam Kaplin, a psychiatrist at Johns Hopkins who’s working with many such patients, names depression as a particular issue.

Kaplin: Crazy high rates of depression, your final downstream common effect of any insult to the brain whether it’s a metabolic insult or an infectious insult. So that’s a big part of this is the inflammation but trying to convince people that it’s the infection that caused this because when they get home they expect, oh I’m home, I should be fine, and they’re not fine. They get sent home and they’ve got at least a month of rehab they have to do to even begin to get back to their old selves, emotionally, physically, all of this.   :32

Kaplin says acknowledging the challenges and seeking treatment for depression will help. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: When someone who’s been hospitalized with Covid-19, coming home can be a challenge, Elizabeth Tracey reports

Helping people to manage coming home after being hospitalized with Covid-19 takes a team, and Adam Kaplin, a psychiatrist at Johns Hopkins who’s working with these patients, says preconceptions both family and patient have need to be examined.

Kaplin: They feel like their family thinks they’re a pariah.  But when they actually ask their family thinks that they don’t want to hug them because they’ve been so ill, they don’t want to be reinfected or something, so they just have to talk about it, just to make it explicit. If you communicate with body language and everything else as opposed to direct communication you’re having a conversation but not controlling the content.  So a lot of times its just go talk, lay it on the line. Oh my husband is really worried about me and that’s why he didn’t hug me and wouldn’t sleep in the room.   :33

Kaplin says open communication about expectations and needs is key. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: What are some of the consequences of ICU stays for Covid-19? Elizabeth Tracey reports

Post-traumatic stress disorder or PTSD is common after ICU stays, as well as a host of other problems. Adam Kaplin, a psychiatrist at Johns Hopkins who is working with many Covid-19 survivors, says one common theme he sees is stigma.

Kaplin: The stigma is such a profound aspect of this. They feel like they’ve got leprosy when they’re there because everybody’s gowned and everything like that, so there’s stigma in the hospital, then they go home and they’re told to isolate from their family because they don’t know how long it’s going to take for them to be negative. They go to their room and they cocoon in their room and now the room becomes the safe place for them, and then they’re terrified of leaving the room.  :27

Kaplin says a big part of his job is helping people to leave the comfort of their room and go to rehab appointments and re-establish more normal relationships with family and friends. He says everyone’s recovery will proceed at its own pace so patience is needed. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Vaping leads to much worse disease when it comes to Covid-19, Elizabeth Tracey reports

Teenagers and young adults who vape are five to seven times more likely to become infected with Sars-CoV2 and develop Covid-19, a recent study found.  David Kass, a cardiologist at Johns Hopkins, isn’t surprised.

Kass: The more we’re learning about vaping the more we’re learning that its basically pro-inflammatory in that the lung is designed to breath air, ideally clean air. That’s it. It’s not designed to breath in smoke, cigarettes, pot, vapes with oils, and so if you’ve got a background where your lung tissue is already damaged whether you know it or not, then you get this, yes, that would make sense, and it is kind of the perfect storm. Why else should a 14 year old who catches this be at risk?    :30

Kass says education among those who vape is clearly needed to dispel two myths: that vaping is safe and that their age alone will protect them against severe Covid-19. He notes that in this study those who used both e-cigarettes and combustible cigarettes were at the highest risk. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Obese men are at especially high risk for severe Covid-19 disease, Elizabeth Tracey reports

Obesity is confirmed as a risk factor for severe Covid-19, a study in Annals of Internal Medicine reports. David Kass, a cardiologist at Johns Hopkins who wrote an accompanying editorial, says these studies provide further evidence of  obesity’s role in disease.

Kass: With obesity the body is not going to be able to deal with immune challenges, other stress challenges. It’s everywhere. And that makes it harder to flip the switch back to people understanding that, I’m not saying its cancer but it is a disease in a sense. It is something that is gradually going to make it harder for you to deal with other stuff. Just like having a really high cholesterol doesn’t hurt you in any obvious ways until you have a heart attack. High blood pressure, it is there, it’s a risk.                :32

Kass points out that younger obese men in these studies were most likely to be impacted, perhaps because their fat tends to be abdominal and more pro-inflammatory. At Johns Hopkins, I’m Elizabeth Tracey.