Health Topics – Johns Hopkins Medicine Podcasts

Anchor lead: As the pandemic rages on, mental health issues may become more prevalent, Elizabeth Tracey reports

What does research tell us on how people respond to crises and how can that help us now during the Covid-19 pandemic? Eric Strain, a psychiatrist at Johns Hopkins, says there are typical phases in people’s crisis response.

Strain: There’s this phase where people are acting in a heroic way and then there’s like a honeymoon phase, then there’s this steep decline with demoralization and disillusionment. I think we’re coming to the end of the heroic phase when we’re starting to see culturally people starting to react against this, to the shutdown, but my concern is what happens with demoralization and disillusionment? We all were running on adrenaline for weeks there. That’s not sustainable. So I think we need to figure out how do we care for each other, for the broader community?  :33

Strain says awareness that many of us are feeling the same way can help us all respond with empathy and patience. He urges people who are feeling despondent to seek help. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: People undergoing treatment for drug addiction during Covid-19 may lack technologies that can be very helpful, Elizabeth Tracey reports

Portable electronic medicine boxes can help dispense needed medications to people who are in treatment for drug addiction, but they most often also need additional technologies. Eric Strain, a drug abuse expert at Johns Hopkins, identifies the issues.

Strain: A lot of patients don’t have the technology that they need for telehealth visits, and that’s become a real issue. They typically have phones, they may not have smart phones, or if they have smart phones they have data plans that limit it they don’t want to use that for a Zoom visit. There are concerns about the confidentiality using Zoom, negotiating EPIC is difficult for some of them. So there’s still some bumps in the road that need to be addressed in some way but certainly there’s a population where it does seem to work.  :30

Strain and colleagues are working to find ways to address these barriers to helping people remain in treatment for drug addiction. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Technology has been able to help some under treatment for drug addiction during the pandemic, Elizabeth Tracey reports

If you’re being treated for drug addiction, coming to a center to get your medicine has many challenges, especially as the Covid-19 epidemic continues. Eric Strain, a drug abuse expert at Johns Hopkins, says technology has been developed that can help.

Strain: We’re moving to these automated systems where medicine can be loaded into a box which automatically opens each day to make the medicine available to the patient without giving them thirty days worth or twenty days worth at a time. It’s kind of a cool thing. The physician who’s making the medicine available to the patient is able to program the box from home, remotely, while the patient gets the box which then has the doses in it.  :30

Strain says the box is helpful to many but cannot be used by others, so other strategies to facilitate treatment for drug addiction are being developed. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Experts in drug addiction are sounding an alarm about vulnerabilities in this population in the setting of the pandemic, Elizabeth Tracey reports

Almost 70,000 people died in 2018 in the United States due to drug overdoses, a number that is eclipsed by Covid-19 deaths so far in 2020. Yet many drug abuse experts, including Eric Strain at Johns Hopkins, warn that in some ways there are parallel epidemics taking place.

Strain: The drug abuse population in general is going to be a vulnerable if they do get infected. This is a population that often has other medical comorbidities, second thing is the treatment systems are not ideally suited for this situation. We have opioid treatment programs or methadone clinics which have traditionally congregated this population often waiting in line to get medicine and bringing them into close quarters with each other, which is really a risky situation for transmission of the virus.  :33

Strain says it’s not known yet how many overdose deaths have occurred during the pandemic, but says ED visits are down quite a lot. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: What can people who leave the ICU after Covid-19 expect? Elizabeth Tracey reports

ICU stays are fraught with challenges, and these continue even after someone leaves the unit. Johns Hopkins has created a special unit to help people who’ve survived an ICU stay with Covid-19 transition. Megan Hosey, a faculty member on the unit, says first of all people need to be gentle with themselves.

Hosey: ICU is a lot like any other major life experience people have. So life is never the same before and after you get married. It’s never the same before and after the death of a parent. And I think ICU is very similar in that it is a challenging experience. When I say they shouldn’t expect life to look the same I just think that we’re giving people the heads up that they’ve experienced a major life event and that might be how they perceive it.  :31

Hosey says acknowledging the challenges of critical illness is the foundation of healing. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: People who’ve been hospitalized with severe COVID-19 may need special rehabilitation, Elizabeth Tracey reports

Getting out of the intensive care unit when you’ve been on a ventilator with severe COVID-19 disease is good news, yet most people will need some additional help to make the transition to home. Johns Hopkins rehabilitation expert Megan Hosey describes what survivors might expect.

Hosey: we’re finding that people need five to seven days after critical illness to really get rounded back up with their activities of daily living to go home. We’re thinking that in patients who survive COVID and the critical illness that can be associated with that will have post intensive care syndrome.  So changes in cognition, including deficits in attention, learning, memory, it might include mental health symptoms like anxiety, depression, PTSD.  :32

Hosey and colleagues at Johns Hopkins have developed an inpatient program to help COVID-19 survivors recover. I’m Elizabeth Tracey.

Anchor lead: What is the role of ventilators in managing severe COVID-19? Elizabeth Tracey reports

When it comes of managing people with severe COVID-19 disease, some clinicians are questioning the need for ventilators, citing low survival rates and lengthy hospitalization. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, offers his opinion.

Garibaldi: At a fundamental level this disease causes ARDS, or acute respiratory distress syndrome. That’s a syndrome that’s been recognized for over fifty years. The only thing that’s really been shown to improve outcome is the way that you ventilate someone, using a low tidal volume ventilation strategy, and I think that we need to make sure that as we’re trying to gather more data about this disease, until we have data that says that that’s not the right way to ventilate these patients, I think we need to go with what twenty years, thirty years of data now has shown what has been effective with ARDS patients, that we know can save lives.  :30

Garibaldi says non-invasive strategies to provide more oxygen to people with severe COVID-19 are well worth trying, but that if ventilators are needed they should be employed. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: People with COVID-19 infection may have low oxygen levels in their blood yet not seem to struggling to breath, Elizabeth Tracey reports

COVID-19 infection sometimes results in low oxygen levels in someone’s blood yet they don’t say they are short of breath and may not seek medical attention until levels are very low. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, describes what he’s seen clinically.

Garibaldi: There’s this term that’s risen up called the happy hypoxic. Or the patient who is requiring lots of oxygen but is not working hard to breath. It’s important to go back to physiology to think about what this could mean. There’s a natural spectrum where some people are much more short of breath at lower oxygen levels than others but I also worry that people are missing subtle findings of increased work of breathing. We know that respiratory rate is notoriously measured incorrectly. It’s very easy to miss someone who is breathing 25 times a minute if you don’t pay attention to it.   :29

Garibaldi says what is known is that very low oxygen levels are dangerous, so he urges clinicians to pay attention to more subtle signs of breathing difficulty. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Using ultrasound helps clinicians track status of COVID-19 infection in real time, Elizabeth Tracey reports

Ultrasound is able to detect lung and heart changes related to COVID-19 infection quickly and reliably, Johns Hopkins critical medicine expert Brian Garibaldi says. He points out additional advantages to the technique.

Garibaldi: You can do it multiple times. You can record your images, you can show those to other people so you can get advice in real time, hey, I just did this ultrasound of so and so’s chest can you take a look at it and let me know if I’ve missed something. You can also do serial exams so it would be really hard to get an echo every day on a patient but if someone’s having problems and you’re worried about their heart, or you’re worried about fluid collections around their lung or their heart, you can do a real time assessment every day, in minutes, to be able to follow the trajectory of that patient longitudinally.  :27

Garibaldi says images previously obtained with CT scans can now be gotten at the bedside, avoiding both transporting critically ill patients and the need to decontaminate the CT scanner, which brings the machine offline for quite some time. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Can using ultrasound at the bedside improve care for COVID-19 patients? Elizabeth Tracey reports

Using ultrasound technology at the bedside of patients with COVID-19 infection is proving very useful in managing the disease. That’s according to Brian Garibaldi, a critical care medicine expert at Johns Hopkins.

Garibaldi: One of the advantages of ultrasound in the time of COVID-19 is that you’re going into the room anyway and you can bring in a portable device that’s easily cleanable to start gathering information that previously was only available to us through CT scan, which requires transportation of the patient out of the unit or echocardiography, which requires having another person come into the unit who otherwise wouldn’t be there, with a much larger device which is potentially more difficult to clean. So it’s really been an opportunity to start using ultrasound more broadly, to try to improve our infection control compliance but also to get information in real time.  :34

Garibaldi says ultrasound has been proving so useful that Johns Hopkins has purchased and deployed many of the devices to help clinicians deliver the best care to their patients. At Johns Hopkins, I’m Elizabeth Tracey.