Health Topics – Johns Hopkins Medicine Podcasts

Anchor lead: Studies are pointing to blood vessel damage as a result of COVID-19 infection, Elizabeth Tracey reports

Children with COVID-19 infection may rarely develop an inflammation of blood vessels similar to another known condition called Kawasaki syndrome. David Kass, a cardiologist at Johns Hopkins, says this blood vessel issue that results in increased blood clotting is also found in some adults with the infection.

Kass: The study that came out related to the pretty rare inflammatory vascular disease in children is paralleled in a way by a case report in the New England Journal of five young adults who all presented with stroke. The most common presentation that we’re seeing is deep venous thrombosis. Fundamentally this idea that there’s a prothrombotic vascular inflammatory state that is occurring I think is becoming increasingly accepted.  : 31

Kass says clinicians are aware of prothrombosis or tendency to develop blood clots and there are medications to help. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Some people with conditions that need urgent medical care may not be seeking it, Elizabeth Tracey reports

Heart attacks and strokes seem to have declined during the COVID-19 pandemic, a look at emergency department data suggest. Yet a deeper look seems to suggest that people are simply choosing not to come to the ED, even when they have symptoms, out of fear of infection. David Kass, a cardiologist at Johns Hopkins, says you should seek care.

Kass: Providers have definitely established a remote telemedicine platform. You shouldn’t be sitting at home with symptoms that are concerning you, those mechanisms have to be used. If we use them appropriately, and they are widely available, through every network I’m aware of, then the probability of something really bad happening that should be avoided, despite the fear of catching something, won’t happen. Use that tool, talk to your doctor, don’t quietly have your chest pain because you’re afraid of catching COVID-19.  :32

At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: When you consider personal choices in the pandemic, what should you consider? Elizabeth Tracey reports

If you’re older you’ve probably already heeded warnings about avoiding Sars-CoV2. Same if you have high blood pressure or heart disease. Now, even if you’re younger but obese, you may want to consider your risk from COVID-19. That’s according to research by David Kass, a cardiologist at Johns Hopkins, and colleagues from around the country, published in the Lancet.

Kass: There was a general sense, if you’re younger you’re probably OK. What our findings suggest is that’s probably not really the case. There are aspects independent of just the weight pressing on the lung that go with obesity that I think make you at somewhat higher risk: diabetes, hypertension, these are all risk factors for a virus that increasingly we’re finding is probably attacking blood vessels as one of its main actions.  :28

Kass says that if you are obese, exercising caution as states reopen, keeping physical distance between you and others, and employing public health recommendations is prudent. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: When people with COVID-19 end up in the ICU obesity may be related, Elizabeth Tracey reports

Internationally, experiences with COVID-19 point to certain risk factors for severe disease and the need for intensive care unit care. David Kass, a cardiologist at Johns Hopkins, and colleagues from around the country, have identified obesity as a major risk factor in a recent analysis in the Lancet.

Kass: We ended up with six centers, from New York, Florida, Washington state, Philadelphia, Cincinnati, with close to 260 patient data sets, three numbers, sex, age and then BMI. And then asked a very simple question: is an ICU population snapshot in America show a relationship between age, and obesity, body mass index. So the youngest patients in the units were definitely the most obese, among the sickest of the COVID-19 patients from around the country.  :33

At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Obesity is emerging as a leading risk factor for severe Covid-19 disease, Elizabeth Tracey reports

High blood pressure, heart conditions, older age – these are all risk factors for more severe Covid-19 disease, and now David Kass, a cardiologist at Johns Hopkins, and colleagues around the country have found that obesity is also a risk, and that’s a problem as the pandemic moves across certain areas of the US.

Kass: In the US it varies but overall the obesity rates are more like 40%. It was also looming that this could be a real issue as the disease went from western California and the Northwest where BMIs in the US are more like Europe and New York, where the average BMI is actually kind of like Europe so 20%ish. Now it’s moving into the South and the Midwest of the nation where obesity rates are higher. You end up seeing more in the 40% range.   :31

Kass says people need to factor this in in their own assessments of risk. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: If you’ve been hospitalized for COVID-19 and are recovering, you may find yourself in a field hospital, Elizabeth Tracey reports

Some patients who’ve been hospitalized with COVID-19 will require ongoing care, and to that end, many organizations are working together to create solutions. Lisa Maragakis, director of infection control at Johns Hopkins, describes the initiatives.

Maragakis: States and public/private partnerships have come together to put together healthcare delivery for patients after discharge. How much capacity is going to be required for rehabilitation services, patients who may have a prolonged time on mechanical ventilation and need to go to a place where they can come off of the ventilator, also opening alternate care center sites such as in convention centers so that we have a way to decompress the hospital.  :32

Maragakis applauds these cooperative endeavors to achieve the best care possible for those recovering from COVID-19. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: US populations with COVID-19 are often younger than those seen elsewhere, Elizabeth Tracey reports

One risk factor for more severe COVID-19 disease that emerged from China and Europe was older age, but as the pandemic has spread across the US, more younger people seem to be requiring hospitalization. That’s according to Lisa Maragakis, director of infection control at Johns Hopkins.

Maragakis: We have seen a much younger population of patients admitted to the hospital and even requiring intensive care and sometimes unfortunately dying from the infection. Initially reports centered around older individuals and those with a lot of comorbidities, underlying heart disease, pulmonary disease, diabetes, and now we see a much wider, in the United States, age distribution, really from the majority of patients from the ages of thirty to sixty.  :33

Maragakis says death rates remain higher in those older than 60. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Why do some people with COVID-19 decline so suddenly? Elizabeth Tracey reports

COVID-19 infection is challenging from a number of clinical perspectives, not least of which is that in some people who seem to be getting better, things may suddenly and dramatically get far worse. Lisa Maragakis, director of infection control at Johns Hopkins, comments.

Maragakis: We’re not sure exactly why this happens. In some cases it may be other organs become involved in the infection and cause the worsening clinical picture. Sometimes this is known to be infection of the heart muscle or multiorgan failure in the setting of the low oxygen levels. Certainly vigilance even for those who are recovering at home or who have been admitted to the hospital and then been discharged we have to be vigilant that even after they seem to have recovered that they may have that clinical worsening.  :31

Maragakis advises that anyone who has been diagnosed with COVID-19 needs to be aware of this possibility and should seek immediate care. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: What does a virus have to do to succeed? Elizabeth Tracey reports

SARS-CoV2 has an agenda, one that helps it spread from one host to another in a quest to make billions of new copies of itself. Lisa Maragakis, director of infection control at Johns Hopkins, describes what constitutes success from the virus’s perspective.

Maragakis: When you look at a pathogen from a pathogen’s standpoint success is sometimes driven by having a lower mortality rate and being more efficient at transmission from person to person but not killing your host. And that’s what we’ve seen with this virus. We are now in the midst of transmission widespread and in all states in the United States and really around the world. We all know I’m sure the significant challenges we are facing.  :28

Maragakis notes that SARS-CoV2 has a number of advantages in its quest, especially the fact that so many people don’t have symptoms at the beginning of the infection but are making many, many copies of the virus and often spreading it readily. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: As we seek to understand SARS-CoV2, it’s worth looking at history, Elizabeth Tracey reports

SARS-CoV2, the virus that causes COVID-19, is just one of the family of coronaviruses that have been around for centuries. Lisa Maragakis, director of infection control at Johns Hopkins, reviews the history.

Maragakis: They have been with us as human pathogens for a very long time and are actually responsible for at least ten if not up to thirty percent of all upper respiratory infections including what we term the common cold, and generally considered to be inconsequential. This particular version of a coronavirus is not at all inconsequential. It follows other family members including SARS and MERS as coronaviruses that cause extremely severe respiratory illness and death in many people.  :33

Maragakis says such an historical perspective may provide important clues with an eye toward slowing the pandemic, developing treatments and vaccines. At Johns Hopkins, I’m Elizabeth Tracey.