Health Topics – Johns Hopkins Medicine Podcasts

Anchor lead: Antibody treatment may point the way to why some people with COVID-19 get critically ill while others don’t, Elizabeth Tracey reports

Antibodies don’t tell the whole story when it comes to the development of critical illness in people with COVID-19. Arturo Casadevall, an expert in antibody treatment of infectious diseases at Johns Hopkins, notes a curious phenomenon.

Casadevall: One of the things that is fascinating is, if you get sick with this and you’re in the ICU, these people have antibody to the virus. But they don’t clear the virus. If you give them convalescent plasma from somebody who’s recovered, they clear the virus. And what’s emerging now is that the initial response is not very good. There are some highly neutralizing antibodies that basically stop the infection dead in its track. Several of these monoclonals have now been made. The problem is going to be ramping up production.  :30

Casadevall notes that for low and middle income countries, making monoclonals in a laboratory would be far too expensive and require expertise that may not exist, but the convalescent plasma treatment is much simpler and more practical. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: In the rather bleak landscape of COVID-19, convalescent plasma emerges as a bright spot, Elizabeth Tracey reports

Convalescent plasma treatment, where antibodies in the blood of someone who has recovered from COVID-19 are given to hospitalized people with the disease, seems to help many patients with COVID-19 infection, and now the FDA is poised to make recommendations regarding its use. Arturo Casadevall, an expert in antibody treatment of infectious diseases at Johns Hopkins, says this story should give everyone hope.

Casadevall: The one thing the United States has done right is plasma. This was an effort that came out of doctors, physicians. There was no government help. this was a grass roots effort. So our society cannot control this thing at least have built within it this capacity for self-association, and mobilization, and we were able to do it. I think the regulators, and to their credit, with caution, they would like to be able to put out a directive.  :27

Casadevall says that while history has supported the use of convalescent plasma for several infectious diseases, the studies were never done to prove its efficacy, but the current pandemic has allowed that to happen. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Is making antibodies to fight COVID-19 in a lab practical? Elizabeth Tracey reports

Researchers think they know which antibodies can kill or neutralize, in science speak, COVID-19. So why not just make that antibody in a lab – a so-called monoclonal antibody - rather than collect a recovered person’s plasma? Arturo Casadevall, an expert in antibody treatment of disease at Johns Hopkins, explains.

Casadevall: If you have a monoclonal you have a defined molecule. You know exactly what your concentration is. You know exactly what your activity is. If you get plasma you have a collection of antibodies with multiple functions. What has been kind of surprising to me and to the regulators is they’ve been measuring neutralizing antibody. But there are many antibodies that do other protective effects that don’t neutralize the virus. Some of these units of plasma that don’t appear to have a high amount of antibody do turn out to be associated in some cases with some degree of efficacy.  :31

Casadevall says both approaches are currently under investigation. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: When should using convalescent plasma to treat COVID-19 be tried? Elizabeth Tracey reports

Convalescent plasma, which is a component of the blood taken from people who’ve recovered from COVID-19, seems to help people who are hospitalized with the infection recover. Arturo Casadevall, an expert in antibody treatment of disease at Johns Hopkins, says timing may be critical to the success of treatment.

Casadevall: For plasma, the emerging data are that it reduces mortality if given early. My own view is that it should be given to anyone who gets admitted to the hospital, because the potential benefit outweighs any small risk and just getting admitted to the hospital has a tremendous likelihood of progression. So I think we’ve got safety, all the indicators are encouraging, we’re missing a definitive, case-controlled randomized trial.  :28

Casadevall says ongoing studies in the US hope to answer the question of efficacy but are still some time away from having sufficient numbers of patients to answer the question, while previous studies in China and Europe stopped early because fewer people were getting sick. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: What is the status of using plasma from people who’ve recovered to treat COVID-19? Elizabeth Tracey reports

Using plasma from people who’ve recovered from an infection to treat those who are currently sick with it is a time-honored practice, with some patients with COVID-19 being treated this way. Is this treatment poised for prime time? Arturo Casadevall, an expert in antibody treatments at Johns Hopkins, comments.

Casadevall: The issue that we’ve been facing is when is the FDA going to provide clear recommendations? They have not done so because they’re trying to find what is called a regulatory angle. The problem that they face is that every single unit of plasma is different. If you recover from COVID, if I recover from COVID and we both donate, what we are donating is different, and so the government, the regulators would like to find a way to standardize, to say you should only use units that have this, and that is where there is a tremendous amount of efforts going on.  :33

Casadevall believes such a recommendation is on the horizon. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: What do excess death data tell us about COVID-19 deaths? Elizabeth Tracey reports

Epidemiologists have looked at death data for the United States for the last four months and calculated what is known as the excess death rate. That’s the number of deaths that have taken place over and above what would have been expected based on historical data. Patricia Davidson, dean of the Johns Hopkins School of Nursing, says many of these deaths are due to COVID-19 but also other conditions.

Davidson: People are avoiding going to the hospital. Forty percent of people in the US have used some form of homeopathic treatment to avoid going to the emergency room. Many people in our population live with chronic conditions, so the fact that people are not attending primary care providers means that we don’t have as close a vigilance of risk factors such as hypertension and cardiovascular disease.   :25

Davidson says avoiding becoming a statistic means seeking medical care when needed as well as adopting public health practices. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Trauma can produce conditions that lead to chronic headache, Elizabeth Tracey reports

How is it that trauma to the head can result in chronic headaches? Sashank Reddy, a craniofacial surgeon at Johns Hopkins, explains.

Reddy: Every nerve in your body is traveling through some specific locus. For your face and scalp those nerves often travel through small spaces called foramena and they can get impinged in those spaces, particularly in the setting of trauma where scar tissue can then build up around them and make a tight locus even tighter, or when the nerve itself swells in a confined space.  :22

Reddy says such a mechanism may resolve with surgery.

Reddy: For a subset of patients with post-traumatic headaches they can be amenable to surgical solutions. I will say that even for those patients with post-traumatic headaches the majority of them can be adequately managed with medical management, that’s the good news.  :14

Reddy says such a procedure usually takes a couple of hours on an outpatient basis. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How can people who are considering surgery for headache be evaluated? Elizabeth Tracey reports

Chronic headaches that develop after trauma or injury can sometimes be alleviated with a surgical procedure, but careful evaluation is needed beforehand. Sashank Reddy, a craniofacial surgeon at Johns Hopkins, describes the process.

Reddy: There are imaging studies that have been done including at Johns Hopkins to help us to understand what can happen to individual nerves in response to trauma or even in other causes of chronic headache. But I would actually say that the most reliable tests here are actually old-fashioned physical exam identifying those trigger points, as well as the response to transient nerve blocks. So these are medicines that numb those nerves or decrease the swelling or inflammation around those nerves for a while, and when patients benefit from those then we know that this is one of the important triggers.  :30

Reddy says every evaluation should start with a neurologist who specializes in headaches, and that the most conservative approaches should be tried first before surgery is undertaken. Those who do choose surgery are likely to get durable results, Reddy notes. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Some people with chronic headaches develop them after trauma, Elizabeth Tracey reports

Injuries to the head can sometimes result in chronic, painful headaches that can be disabling. In some cases those headaches may be treatable with a procedure, says Sashank Reddy, a craniofacial surgeon at Johns Hopkins.

Reddy: For certain patients with headaches they can be triggered or at least a significant component of their pain, is due to pressure or damage to peripheral nerves across the face and scalp. We have these nerves all over our body, they’re responsible for normal pressure and touch sensation. But sometimes when they get compressed or damaged they can trigger pain locally or that can manifest in headaches. So in patients like that when we’ve narrowed down that diagnosis and it still persists, we can alleviate pressure on those nerves through surgical approaches, and in some cases nonsurgical approaches.  :31

Reddy says very careful evaluation is necessary to determine whether someone’s headaches are likely to respond to surgery before such an approach is taken. In suitable people though headaches may be entirely or mostly relieved afterward. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Headaches are very common and some may actually be cured, Elizabeth Tracey reports

Half to three-quarters of all adults in the world will report a headache at least once in the last year, global data indicate, and for some of those people the condition is chronic. Sashank Reddy, a craniofacial surgeon at Johns Hopkins who treats some headaches surgically, describes the scope of the problem.

Reddy: Many people will get occasional headaches but the more problematic kind, the headache disorders, like migraine headaches or chronic headaches, are surprisingly common. For patients who suffer from them they can be a source of significant disability, missed work and other sorts of problems. The quarterback of an effective headache management strategy is always a neurologist. There are within neurology specialists in headache medicine. As our understanding of various types of headaches has increased over time there are more and more medical and nonmedical options for dealing with those headaches.  :33

Reddy says a visit to a primary care physician is your first step if you have chronic or debilitating headaches. At Johns Hopkins, I’m Elizabeth Tracey.