Health Topics – Johns Hopkins Medicine Podcasts

Anchor lead: Does personal protective equipment prevent infectious disease among healthcare workers? Elizabeth Tracey reports

Personal protective equipment or PPE may not adequately prevent infections among healthcare workers, a recent study concluded, with those working in the healthcare field 3.4 times more likely to become infected with COVID-19 than those not working in the field. Patricia Davidson, dean of the Johns Hopkins School of Nursing, comments.

Davidson: We really to need learn a lot more from what people have done in the global health settings, that have taken care of these very infectious rampant diseases. Because much of what we have done in developed nations more often than not PPE has been about protecting the patient. The majority of where PPE is worn people have had bone marrow transplants, people with immunosuppression. So we really need to think about what is an appropriate occupational health and safety model for the future.  :34

At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: For women who’ve survived childhood cancers, how can their risk of breast cancer be reduced? Elizabeth Tracey reports

Girls who receive cancer treatment that may involve radiation to the chest area are at increased risk for subsequent breast cancer. Now a new study shows that MRI is the best method to screen them. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, comments.

Nelson: What they saw is that if you started screening at age 25 and you used annual mammography plus annual MRI you avert 56 to 71% of the deaths you’d see among people who weren’t screened. And when they did some cost effectiveness analysis trying to balance the cost of things like MRI every year against the outcomes, it looked like it might be better to start screening at age 30. I think what you see although this is modeled is this is going to be the best we can do to generate recommendations.  :29

Nelson applauds this study as part of the effort to identify best practices for those who’ve survived cancer, whether as adults or children. He points to the need for a comprehensive strategy for survivors, a group that is blessedly growing. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Allowing more people to get Medicaid reduces the risk for advanced cancer, Elizabeth Tracey reports

When the Affordable Care Act was implemented, many more people, especially those at lower incomes, were eligible for benefits under Medicaid. Now a new study shows that having that coverage reduced their risk for being diagnosed with an advanced cancer. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the findings.

Nelson: What they found was a fifteen percent reduction or so of the odds of developing very advanced cancer, cancers that had spread throughout the body, we call metastatic cancer. There’s a fifteen percent lower chance of getting that in the second period after Medicaid expansion than in the period before. And they look in people with private insurance they didn’t have this change in the second period versus the first period so this does seem to be unique to this population. :26

Nelson notes that this reduction in advanced cancers is likely real since it wasn’t seen during the same period in those with private insurance, and argues for extension of these benefits to low income people, who may avoid seeking healthcare because of cost. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: More people should now be screened for lung cancer, Elizabeth Tracey reports

More people now meet the criteria for lung cancer screening, if new guidelines from the United States Preventive Services Task Force are implemented. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the update.

Nelson: They have proposed to change the guidelines by dropping the age to start screening from 55 years old to 50 years old. That may be more beneficial to African Americans at risk for lung cancer because if you look at the age distribution when they develop the disease it is at a little bit younger age. And then they backed off on the pack year recommendation from 30 pack years to 20 pack years. That may actually benefit women. Women seem to be more likely to get lung cancer by smoking less than men do.   :31

Nelson reminds everyone that the single best strategy for avoiding lung cancer is not to smoke, or to stop as quickly as possible, since after 15 years your risk drops to that of a never-smoker. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Data are accumulating on infection and death relative to Covid-19 among healthcare workers, Elizabeth Tracey reports

Even with personal protective equipment, a recent Lancet study reports that healthcare workers are more than three times as likely to contract Covid-19 as people who don’t work in healthcare, while death rates are disturbingly high also. Patricia Davidson, dean of the Johns Hopkins School of Nursing, says more intensive study is needed.

Davidson: One of the things that has been very troublesome to many people around the world has been the number of healthcare worker deaths. More than that is how little we know about the numbers of people that have died. In nursing homes there’s been about 767 deaths reported amongst healthcare workers. I think this is a time where we really need to look at our occupational health and safety models, to make sure our healthcare workers are protected.  :30

Davidson notes that procedures for donning and doffing protective equipment, especially in taking it off, need greater scrutiny, with those institutions that are vigilant keeping risks lower. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: What are the challenges of HIV care during the Covid pandemic? Elizabeth Tracey reports

HIV and TB are poised to resurge following Covid-19, public health experts warn in a recent Lancet publication. Joseph Cofrancesco, an HIV expert at Johns Hopkins, says challenges facing those with HIV here in the US underscore conditions that make resurgence more likely.

Cofrancesco: The day to day operations for patients are tougher. Virtual visits, though very good, are not quite the same as live visits, and many of the patients in my own practice and certainly in the United States simply don’t have the technology, or frankly the finances to have the technology, to do those kinds of visits. I’ve had at least one or two patients tell me they’ve had an interruption in their meds for a few days, because the pharmacy couldn’t get it.  :28

Cofrancesco says that if such barriers are present in a high resource setting like the US even more profound challenges face those in low and middle income countries. He hopes that a Covid vaccine will soon be available so other important health issues also get attention. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Public health experts are sounding warnings about more HIV in the wake of Covid-19, Elizabeth Tracey reports

As the world’s attention is taken up by Covid-19, will we see resurgences of TB and HIV? That’s the concern of global public health experts, who warn that just as is the case with Covid-19, no country will remain unaffected by increases in these two infectious diseases. Joseph Cofrancesco, an HIV expert at Johns Hopkins, comments.

Cofrancesco: The pessimist in me says clearly this is going to disrupt things and make for horrible problems. The Lancet Global Health published the article that looked at this and said, based upon this different modeling that the worst case scenario is that there will be 10% more deaths worldwide due to HIV in the next five years. Now that’s modeling but its pretty good modeling. The optimist in me says we will get a vaccine and we’ll get this under control.   :31

Cofrancesco notes that both HIV and TB rates were declining globally with worldwide public health cooperation, and hopes that will resume. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Does having HIV put someone at higher risk for severe Covid infection? Elizabeth Tracey reports

Covid-19 is putting worldwide efforts to contain both HIV and tuberculosis at risk, after the best year yet for containment in 2018. Joseph Cofrancesco, an HIV expert at Johns Hopkins, says it still isn’t known exactly how Covid infection affects someone with HIV.

Cofrancesco: There’s some thought that if you are well controlled and you’re taking your meds and you have a high CD4 count, your risk should not be substantially higher than than someone who doesn’t have HIV. But the lower your CD4 count and certainly if you’re not on treatment your risk would be substantially higher. There are however some suggestions at least but I don’t think we have the data yet to support it that HIV itself may be an independent risk for having more severe illness with COVID if you get it.   :28

Cofrancesco says the best advice is to avoid all infectious diseases if possible, and if you already have HIV, to keep up to date on your medications to keep your viral count undetectable, since undetectable means you cannot transmit the infection to someone else. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: More people are reporting mental health problems as the pandemic rages on, Elizabeth Tracey reports

Mental health problems are spiking along with rising COVID-19 cases in many parts of the world, the Lancet reports. Eric Strain, a psychiatrist at Johns Hopkins, says he isn’t surprised.

Strain: I think it’s spot on correct. I think we’re seeing people who are very socially isolated and despondent. Because the responsible thing, they feel, is to stay at home, to be wearing a mask, to not be out in public, but we all need those experiences, to be out, to be seeing people, to have physical contact with other people. To hug a friend, to shake a hand. Those are things that carry some valence of meaning to us, which we now, if we’re being responsible, avoid doing.  :32

Strain says accessing tools such as Zoom and FaceTime can help, but that there’s no substitute for in person interaction. He recommends planning limited interactions with others and contacting a mental health expert if needed. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Overdose deaths are increasing along with COVID-19 mortality, Elizabeth Tracey reports

Deaths from drug overdoses are reaching record levels even as those from COVID-19 continue to climb, CDC data reveal. Eric Strain, a drug abuse expert at Johns Hopkins, says there are many factors to consider.

Strain: Overdose deaths are up, and in some respects it seems like these death rates are getting obscured with the appropriate concerns about COVID. The overdose deaths are also concerning because we’re seeing more stimulant overdose deaths. So methamphetamine, cocaine. Those rates are going up. Now it may be that they’re combined with opioids but there’s some concern that we’re so focused on opioids that we’re missing the fact that methamphetamine use and cocaine use are going up as well.  :29

Strain asserts that many of these overdose deaths are likely deaths of despair, or intentional overdoses. He says that programs at Johns Hopkins and elsewhere are working hard to identify risk factors and barriers to treatment. I’m Elizabeth Tracey.