Story Tips from Johns Hopkins Experts on Covid-19

FIVE THINGS YOU MAY NOT KNOW ABOUT VACCINE SCIENCE

Vaccines that prevent infection by SARS-CoV-2, the virus that causes COVID-19, are being rolled out around the world. Below are five things about vaccine science of which you may be unaware. Additionally, here is a video about how vaccines are determined safe.

• Two of the vaccines being developed use a technology that involves mRNA, tiny bits of genetic code that a cell uses to produce proteins. Research using mRNA as a treatment began in the 1990s to help cells replace proteins they lack due to genetic disorders. The research stalled when scientists found that mRNA treatments in animal models prompted a large response from immune system cells that could potentially hamper the treatment. Now, scientists have leveraged the ability of mRNA therapies to induce the immune responses needed for developing the current SARS-CoV-2 vaccines.

• Modern vaccines, including the most recently developed version of the shingles vaccine, may contain “adjuvants” — chemical compounds designed to enhance the immune system to respond in a certain way. Because adjuvants tend to bring on significant immune activity, they can make some people who receive vaccines containing them feel temporarily ill, including symptoms such as fatigue and pain at the vaccine site.

• Some viruses are more difficult to immunize against and develop a vaccine. That is why there is no vaccine yet for HIV and other viruses that can cause serious illnesses.

• Tests of people who were vaccinated against SARS-CoV-2 in research studies indicate that the participants produced higher levels of antibodies that neutralize the virus. By comparison, people infected with SARS-CoV-2 who develop COVID-19 have much lower levels of the neutralizing antibodies. Since data indicate that the newly developed vaccines prompt the body to develop high levels of antibodies to SARS-CoV-2, researchers say that these vaccines may offer the best opportunity to achieve immunity to the virus over large populations.

• Basic science research has resulted in many of the advances in modern vaccine science, from understanding how the virus invades a cell to the mRNA technology that began nearly 30 years ago.

Johns Hopkins Medicine scientists and clinicians are available to discuss how vaccines work, the evolution of vaccine technology and the basic science that fostered this research.

PHYSICIANS SAY NON-CONTACT INFRARED THERMOMETERS FALL SHORT AS COVID-19 SCREENERS

While a fever is one of the most common symptoms for people who get sick with COVID-19, taking one’s temperature is a poor means of screening who is infected with the SARS-CoV-2 virus that causes the disease, and more importantly, who might be contagious. That’s the conclusion of a perspective editorial by researchers at Johns Hopkins Medicine and the University of Maryland School of Medicine that describes why temperature screening — primarily done with a non-contact infrared thermometer (NCIT) — doesn’t work as an effective strategy for stemming the spread of COVID-19.

The editorial was published Dec. 14, 2020, in Open Forum Infectious Diseases, the online journal of the Infectious Diseases Society of America. The authors are William Wright, D.O., M.P.H., assistant professor of medicine at the Johns Hopkins University School of Medicine, and Philip Mackowiak, M.D., M.B.A., emeritus professor of medicine at the University of Maryland School of Medicine.

In March 2020, the U.S. Department of Health and Human Services and the U.S. Centers for Disease Control and Prevention released guidelines for Americans to determine if they needed to seek medical attention for symptoms suggestive of infection with SARS-CoV-2, with temperature screening playing an integral role. According to the guidelines, fever is defined as a temperature — taken with an NCIT near the forehead — of greater than or equal to 100.4 degrees Fahrenheit (38.0 degrees Celsius) for non-health care settings and greater than or equal to 100.0 degrees Fahrenheit (37.8 degrees Celsius) for health care ones. This is the first aspect of COVID-19 screening by temperature that Wright and Mackowiak question in their editorial.

“Readings obtained with NCITs are influenced by numerous human, environmental and equipment variables, all of which can affect their accuracy, reproducibility and relationship with the measure closest to what could be called the ‘body temperature’ — the core temperature, or the temperature of blood in the pulmonary vein,” says Wright. “However, the only way to reliably take the core temperature requires catherization of the pulmonary artery, which is neither safe nor practical as a screening test.”

In their editorial, Wright and Mackowiak provide statistics to show that NCIT fails as a screening test for SARS-CoV-2 infection.

“As of Feb. 23, 2020, more than 46,000 travelers were screened with NCITs at U.S. airports, and only one person was identified as having SARS-CoV-2,” says Wright. “In a second example, CDC staff and U.S. customs officials screened approximately 268,000 travelers through April 21, 2020, finding only 14 people with the virus.”

From a November 2020 CDC report, Wright and Mackowiak provide further support for their concern about temperature screenings for COVID-19. The report, they say, states that among approximately 766,000 travelers screened during the period Jan. 17 to Sept. 13, 2020, only one person per 85,000 — or about 0.001% — later tested positive for SARS-CoV-2. Additionally, only 47 out of 278 people (17%) in that group with symptoms similar to SARS-CoV-2 had a measured temperature meeting the CDC criteria for fever.

Another problem with NCITs, Wright says, is that they may give misleading readings throughout the course of a fever that make it difficult to determine when someone is actually feverish or not.

“During the period when a fever is rising, a rise in core temperature occurs that causes blood vessels near the skin’s surface to constrict and reduce the amount of heat they release,” Wright explains. “And during a fever drop, the opposite happens. So, basing a fever detection on NCIT measurements that measure heat radiating from the forehead may be totally off the mark.”

Wright and Mackowiak conclude their editorial by saying that these and other factors affecting thermal screening with NCITs must be addressed to develop better programs for distinguishing people infected with SARS-CoV-2 from those who are not.

Among the strategies for improvement that they suggest are: (1) lowering the cutoff temperature used to identify symptomatic infected people, especially when screening those who are elderly or immunocompromised, (2) group testing to enable real-time surveillance and monitoring of the virus in a more manageable situation, (3) “smart” thermometers — wearable thermometers paired with GPS devices such as smartphones, and (4) monitoring sewage sludge for SARS-CoV-2.

Wright is available for interviews.

TELEMEDICINE NEEDED TO DIAGNOSE AND TREAT DYSPHAGIA IN COVID-19 PATIENTS, DOCTORS SAY

COVID-19 and SARS-CoV-2, the virus behind the disease, have caused health care providers to change how they treat patients. Clinicians are now frequently using telemedicine to see their patients for routine checkups, saving office visits for emergencies. The same goes for rehabilitation. For example, researchers are looking for ways to improve the screening, assessment and treatment of patients with COVID-19 and dysphagia — swallowing difficulties — by doing it remotely.

Health care professionals whose work puts them in contact with the body areas frequented by SARS-CoV-2 — such as the nose, mouth and airway — share a responsibility for engaging patients in a manner that won’t add to the spread of COVID-19. Risks need to be weighed before screenings, assessments and treatments are undertaken.

Ideally, clinicians assess dysphagia through a clinical (bedside) evaluation and one of two standard tests: a videofluoroscopic swallow study or a flexible endoscopic evaluation of swallowing. These exams determine swallowing ability, look for changes in the anatomy and movements of the larynx and tongue, analyze airway vulnerability, and measure other characteristics related to swallowing physiology.

However, during the pandemic, clinicians diagnosing and treating dysphagia in COVID-19 patients are putting themselves at risk by using these up close and physical techniques. And simply relying on methods such as medical history reviews and patient reporting of symptoms is not enough.

“The irony is that patients with COVID-19, especially those who were recently removed from mechanical ventilation in intensive care units, may be among those who most need the clinical and instrumental exams for properly and comprehensively assessing dysphagia,” says Martin B. Brodsky, Ph.D., Sc.M., associate professor of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine.

Therefore, in an editorial in the September 2020 issue of the Archives of Physical Medicine and Rehabilitation, Brodsky and colleague Richard Gilbert, M.D., with the Laboratory for Biological Architecture at the Providence VA Medical Center, say it’s time to embrace telemedicine for dysphagia.

“To make that happen, there needs to be continued engagement by clinicians with third-party payers — including insurance companies, and state and federal government programs such as Medicare — to get support, acceptance and financial coverage for the use of telemedicine in this way,” he explains.

Treating dysphagia remotely is not new, having been researched and practiced (to a smaller extent) for nearly 20 years. However, more widespread use had previously been hampered by technological difficulties, high expense of equipment, lack of standardized training, and billing and coverage issues.

That all changed, Brodsky says, with the arrival of COVID-19.

“Although vast improvements in telemedicine for dysphagia have been made in recent years, patients continue to be limited in their ability to receive effective remote care,” Brodsky says. “With the current pandemic, we need that to change because the traditional clinical and instrumental exams used for assessing dysphagia are putting health care workers who treat patients with COVID-19 at risk for contracting and further spreading the disease.”

“We need innovative thinking and technologies to be rapidly translated into clinical practice to enable telemedicine services for dysphagia — now, more than ever,” adds Brodsky.

Brodsky is available for interviews.

JOHNS HOPKINS MEDICINE EXPERT WEIGHS DEVASTATING IMPACT OF COVID-19 ON HEALTH CARE WORKERS

During the COVID-19 pandemic, health care workers have been at the forefront of the battle against the life-threatening illness. Sadly, they are not immune to the effects of the disease. Many have contracted COVID-19, and some have died.

In a paper published Dec. 4, 2020, in the journal PLOS One, Junaid Razzak, M.B.B.S., Ph.D., director of the Johns Hopkins Center for Global Emergency Care, and his colleagues estimated the impacts of COVID-19 on the U.S. health care community based on observed numbers of health care worker infections during the early phase of the pandemic in Hubei, China, and Italy, areas that experienced peaks in COVID-19 cases before the United States.

“We looked at what was known from other countries earlier in the pandemic and modeled the impact on the health of the front-line health care workers in this country to see what gains were possible here if known interventions were applied,” says Razzak, who is a professor of emergency medicine at the Johns Hopkins University School of Medicine.

Using a Monte Carlo risk analysis simulation model to predict outcomes and based on data from China and Italy, Razzak and his team estimate that between 53,000 and 54,000 U.S. hospital workers could become infected with COVID-19 during the course of the pandemic. The team projects the number of U.S. hospital worker deaths for the same time period at approximately 1,600.

The estimates by the researchers also suggest that if health care workers considered high risk — including those over age 60 — wore appropriate personal protective equipment — such as gowns and face masks — the number of infections would decrease to about 28,000 and the number of deaths to between 700 and 1,000. If hospital workers age 60 and over are restricted from direct patient care, then the predicted numbers could drop to 2,000 infected and 60 deaths.

Razzak and his team say that since the current COVID-19 mortality among U.S. health care workers has surpassed their original estimates, it proves that this group bears — and will continue to bear — a significant burden of illness due to COVID-19.

“Our analysis shows that continuous widespread and proper use of personal protective equipment, along with limiting exposure for hospital workers over the age of 60, are necessary measures for this country to take now,” Razzak says. “These efforts will save the lives of health care workers who will then be able to save the lives of others infected with COVID-19.”

Razzak is available for media interviews.

STUDY SUGGESTS REPORTING OF SEXUALLY TRANSMITTED INFECTIONS MAY BE IMPACTED BY COVID-19

With the health care community heavily focused on COVID-19 since the first quarter of 2020, there have been concerns that reporting of other diseases — and the resulting data that enables them to be more effectively treated and controlled — may have been impacted. For example, little is known about how the pandemic may have affected the reporting of sexually transmitted infections (STIs).

To address that issue, researchers at Johns Hopkins Medicine recently analyzed the number of reported cases of STIs within the United States during the first 40 weeks of 2020 and compared the counts with those recorded for the same period in 2019. And because the COVID-19 outbreak was first declared a U.S. national emergency on March 13, 2020 — near the end of week 11 — the researchers used that as the starting point for comparing reported STI cases in 2020 with the number of COVID-19 cases documented in weeks 12 through 40 of 2020.

Their findings were reported online Nov. 1, 2020, in the journal Sexually Transmitted Infections.

For their study, the researchers obtained numbers of cases for COVID-19 and three STIs — chlamydia, gonorrhea and syphilis — from the National Notifiable Diseases Surveillance System managed by the U.S. Centers for Disease Control and Prevention (CDC).

Comparing weekly incident case counts in 2020 from weeks 1 through 11 with weeks 12 through 40, the researchers found decreases for two of the STIs — 20.2% for chlamydia and 3.0% for gonorrhea — while there was a 5.5% rise in reports of syphilis cases. Comparing cumulative year-to-date case reporting data at week 40 in 2019 with the same time period in 2020, the researchers found decreases in chlamydia (18.2%) and syphilis (6.9%) but no significant change in gonorrhea numbers (a 0.06% decrease).

When compared with the number of cases reported each week for COVID-19 during weeks 12 through 40 of 2020, the weekly numbers for the three STIs appeared to inversely rise or fall for the most part with the coronavirus counts. In other words, periods of heavy COVID-19 case reporting seemed to coincide with fewer STIs being counted.

Additionally, the Johns Hopkins Medicine team showed that the reported case numbers for 42 of the 44 nationally notifiable diseases tracked by the CDC decreased from 2019 to 2020 for weeks 1 through 40. The researchers say that this possibly indicates the observed effect may impact infectious diseases other than STIs.

“It isn’t clear whether or not the decreases seen in reported cases of chlamydia, and to a lesser extent, gonorrhea and syphilis, were because COVID-mediated physical distancing was preventing transmission or, more likely, that there was a decrease in testing and reporting of cases, with fewer people seeking medical attention for STI symptoms during the pandemic,” says Matthew Crane, a medical student at the Johns Hopkins University School of Medicine and lead author of the study.

Based on their findings, the researchers believe there is a critical need for innovative strategies — such as patient-collected and mailed specimens — to counter any impacts in case reporting during a pandemic.

Crane is available for interviews.

RAVENS HONOR JOHNS HOPKINS HOSPITAL’S WICE AS ‘HOMETOWN HERO’

Before its Dec. 8, 2020, National Football League game against the Dallas Cowboys, the Baltimore Ravens named Johns Hopkins Hospital staff member Joseph Wice as a “Hometown Hero.” The award honors line-of-duty heroes, such as first responders and military members, and “everyday heroes” who have distinguished themselves in their careers or in service to the community.

Wice has worked as an environmental care (EVC) associate at The Johns Hopkins Hospital since 2017. Before he began his current job, Wice was diagnosed with acute promyelocytic leukemia, an aggressive form of blood cancer. After a four-year battle — including nearly four months in the hospital and 1 1/2 years of chemotherapy — Wice’s cancer went into remission in September 2016.

Since he started working at The Johns Hopkins Hospital, Wice has used his story of recovery to inspire and connect with patients he meets through his work on the surgical intensive care unit. “It may not be the same illness they are going through, but I do it because I actually understand the position they’re in,” Wice says.

When the COVID-19 pandemic began in early 2020, Wice stepped up to provide much-needed assistance even though he is considered immunocompromised. With his oncologist’s approval, Wice took on additional shifts to help as more and more patients with COVID-19 were admitted. This required him to don personal protective equipment to do his job.

“Environmental care is the first line of defense against germs,” Wice says. “It all starts with us.”

“Every time I see Joe, he is working so hard, and has the most positive attitude,” says Lauren Potter, a registered respiratory therapist who works in the same unit with Wice. “He never complains, and goes above and beyond without being asked. Joe is a positive influence on us all.”

Wice is thankful for being recognized as a Baltimore Ravens Hometown Hero and calls the honor “exciting and humbling.” He’s just as proud of the work he does at the hospital.

“I love coming there,” Wice says. “I love working for Johns Hopkins.”

Wice is one of eight recipients of the Hometown Hero award this football season and received tickets to a Ravens game next season. The team also saluted Wice in a video posted on its website.

Wice is available for media interviews.

WHAT’S AN EMERGENCY USE AUTHORIZATION? JOHNS HOPKINS MEDICINE EXPERT EXPLAINS IN VIDEO

On Dec. 10, 2020, a U.S. Food and Drug Administration advisory committee granted emergency use authorization (EUA) status for a recently developed and clinical trial-tested COVID-19 vaccine to make it available to the public.

In a two-minute video, Anita Gupta, D.O., Pharm.D., M.P.P., an adjunct assistant professor of anesthesiology and critical care medicine and pain medicine at the Johns Hopkins University School of Medicine, explains what an EUA is and how it can help health care workers bring the coronavirus pandemic under control.

Gupta is available for media interviews.