Health Topics – Johns Hopkins Medicine Podcasts

Anchor lead: Sheltering at home may put children and spouses at risk for domestic abuse, Elizabeth Tracey reports

COVID-19 has driven many people to sheltering at home, but that may not be a safe place for children and spouses, as domestic abuse has increased substantially, recent data show. Rachel Thornton, a pediatrician at Johns Hopkins, says transitioning to televisits presents additional challenges in identifying and helping those at risk.

Thornton: When we’re doing a televisit, and we don’t know who else is overhearing the conversation, we always tread cautiously because we know that we don’t want to put people who are in a compromised or potentially compromised situation further in harm’s way by asking at the wrong time or raising suspicions. We do our best to assess for confidentiality when we’re talking to people in their homes, to ask their comfort level with disclosing sensitive information, to give them a heads up that we’re going to be asking about these things.  :31

Thornton says pediatricians are available to help both children and their parents. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Even when a vaccine against COVID-19 is developed, additional issues will need to be addressed, Elizabeth Tracey reports

At least five vaccine candidates have been chosen by the federal government to move forward into further testing and ramping up for production. Andrew Pekosz, a vaccine expert at Johns Hopkins, says one unknown that will only be revealed with time is how long antibodies in response to the vaccine will persist.

Pekosz: One of the things that will be important is the longevity of these responses. We also have to realize that we’re going from a population which is basically naïve to this virus, and trying to get people with a vaccine to be protected. Oftentimes that’s going to take multiple doses of a vaccine. I think the flu vaccine infrastructure is probably a good model to use, because we try to immunize 100 million people in a short period of time so there are things that we can learn from the way that we try to distribute and give flu vaccines, that might help with the Sars-CoV2 vaccine.  :34

At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: The vaccine candidates for COVID-19 offer hope, and may be here sooner than we think, Elizabeth Tracey reports

Vaccines based on proteins and nucleic acids are some of the candidates for a vaccine against COVID-19, and almost all of them utilize technology quite different from that used to make other kinds of vaccines. Andrew Pekosz, a vaccine expert at Johns Hopkins, says this shift is likely to bear fruit, and federal agencies are supporting it.

Pekosz: If you can find a good vaccine that works in 100 people, or 1000 people, how do you get from that to immunizing 10 million people in a reasonable amount of time. I think that’s one credit to the federal government response right now, is that people are thinking a few steps ahead of the time, and they are investing in manufacturing capabilities of some of these companies, it’s a bit of a gamble, it’s a risk. They’re assuming that some of these will work, and so they’re investing in the manufacturing capabilities of some of these companies so that they can scale up.  :29

Pekosz says everyone can also have confidence that oversight is rigorous and that safety as well as efficacy are front and center. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How are today’s efforts at developing a vaccine for COVID-19 different? Elizabeth Tracey reports

Flu vaccines take several months to produce, and that’s because they’re mostly made using a chicken egg as a place for the virus to multiply, then the vaccine must be purified and packaged. COVID-19 vaccines are being developed using an entirely different process, says Andrew Pekosz, a vaccine expert at Johns Hopkins.

Pekosz: There really has been a push to develop what’s called vaccine platforms. Those are basically ways that you can express viral proteins that can generate immune responses and it’s sort of a plug and play version. The vaccine platform doesn’t care what sort of viral protein you put in, it’s just been optimized to make sure that whatever you put into it is expressed at a high level and generates these antibody responses. What you’re seeing now is the fruits that we’re reaping from that basic science investment.  :28

Pekosz says that while the process should take much less time to produce a vaccine against Sars-CoV2, ramping up to make sufficient doses is still a challenge. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: If you’ve had COVID-19 once, can you get it again? Elizabeth Tracey reports

Even as most of the world struggles with the COVID-19 pandemic, many experts are concerned about whether those who’ve been infected once can contract the infection a second time. Andrew Pekosz, a vaccine expert at Johns Hopkins, comments.

Pekosz: Reinfection of course is obviously something that has to be monitored very carefully. Remember we’ve just gotten through the first couple month of this so there hasn’t been much opportunity for people who have gotten infected once to actually have been infected a second time, and what’s most important is monitoring people for how long their antibody responses stay high after being infected. With some coronaviruses the antibody levels drop within a few months after infection. With others they stay relatively high for a few years. We’re hoping that Sars-CoV2 fits that latter category, but we need to monitor that to make sure that that’s happening. :35

Pekosz says animal models also seem to point to immunity for a time from reinfection but only longer term data will provide a definitive answer. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Testing for Sars-CoV2 may be either for diagnosis or to assess exposure, Elizabeth Tracey reports

Are you being tested for COVID-19? If you’re ill that is likely a test looking for the virus, while if you’re wondering if you’re immune it’s one for proteins in the blood called antibodies. Andy Pekosz, a vaccine expert at Johns Hopkins, says the latter may provide helpful information.

Pekosz: So far everything looks like if you’ve got good neutralizing antibody responses, there really is no evidence so far of you being able to be infected again.  :08

Pekosz notes that sometimes the tests for the virus seems to remain positive for a prolonged period.

Pekosz: Oftentimes those don’t correspond to actual live virus or active virus. They correspond to to just shreds of RNA that are present, they correspond to dead cells  that are still hanging around that your immune system is in the process of cleaning up, so some of these issues with this controversy around reinfection stem from the fact that people are testing positive for some time after infection for these small pieces of RNA.  :24 

At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Are people who have advanced cancer at high risk for opioid overdose? Elizabeth Tracey reports

People with advanced cancers are often on opioid medications. A new study examines whether they are at higher risk for overdose death as a result. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says the most recent data seems to conclude they are not.

Nelson: The opiate epidemic may be important in the care of cancer patients but the risk for death related to opiates is substantially less and of course we’re asking our oncologists and palliative care specialists to walk a very fine line in this space. No one wants anyone to have to suffer with cancer pain particularly if they’re nearing the end stages of their life where every moment is precious in order to interact with family members. You’d like them to be awake with the amount of dignity they can muster, free of pain and able to live out their life as best as they can.   :33

Nelson says federal agency oversight takes cancer diagnoses into account. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Shorter courses of radiation for cancer therapy will work for most, Elizabeth Tracey reports

Radiation therapy for cancer used to be given over weeks, but modifications to the technique have allowed the time course to be compressed for most patients. Now a Johns Hopkins study shows that many doctors aren’t using the shorter course. William Nelson, director of the Kimmel Cancer Center, explains the data.

Nelson: Now that they can aim better, damage to the normal tissues is stunningly less. They can deliver it over a week. with that in mind, this group looked at the Medicare database. What they found was that among 382 radiation oncologists a third of them still used the prolonged course of treatment, had not converted over to using the shorter term course. They were typically older, more likely to practice in the South, or the middle of the country. The rate of adoption of a new technology hasn’t been as rapid as I think many people think.  :34

Nelson says anyone who needs radiation therapy should ask their physician about the shorter course. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Should you resume routine cancer screening tests? Elizabeth Tracey reports

Since the COVID-19 pandemic began, routine screening tests for cancer have fallen dramatically, a study by medical records vender EPIC shows. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says surveys point to fear of infection.

Nelson: As we’re open for business there is still a little bit of reticence. The screening and early detection has not bounced back very quickly. There are some survey tools out that all say the same thing, that many people are reticent to visit healthcare facilities at all. They feel that this is the kind of place that you might be at high risk to catch a Sars-CoV2 infection. Nothing could be farther from the truth. Look, these are the risks here, these are the risks there, its time to pay attention to your cancer screening, and oh, by the way to your blood pressure checks, your cholesterol screening, and many other things that you may have deferred.  :34

Nelson notes that underserved populations also need to think about routine screenings to avoid some of the conditions that put them at high risk for COVID-19 infections. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: It’s time to resume routine cancer screenings, Elizabeth Tracey reports

Are you avoiding cancer screening tests because of the COVID-19 pandemic? A recent study shows that many people are. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says the numbers are startling.

Nelson: Clearly cancer is an illness that is not going to go away by having people stay at home. What this article dives into is what about the screening itself? The study itself came from a medical records vendor EPIC and they looked in their medical records database. What they saw is between March 19 and April 20 compared to steady state eleven or twelve weeks last year they saw a stunning in appointments for cancer screening. They were down at least 68% for cervical cancer, colonoscopy down 86% and mammography down 94%.  :34

Nelson notes that there’s no question that catching cancer early is most likely to result in good outcomes, so resuming screening is your best strategy. At Johns Hopkins, I’m Elizabeth Tracey.