COVID-19 STORY TIP: FRONT-LINE WORKER STORY — CHERYL CONNORS — RISE
It seems there will never be enough “thank you’s” for the incredible doctors, nurses, technicians and support staff members who are working around the clock to help patients who have the dangerous coronavirus disease. The dedication, determination and spirit enable Johns Hopkins to deliver the promise of medicine.
Cheryl Connors, D.N.P., is the director of Johns Hopkins’ Resilience in Stressful Events (RISE) program, which provides trained emotional support for Johns Hopkins Hospital employees who encounter stressful patient related events. In conversations with staff members during the COVID-19 pandemic, Connors helps front-line care workers cope with fears of being exposed to the virus and exhaustion from working long hours in personal protective equipment.
Connors is available for interviews.
TIPS FOR PARENTS BEFORE SENDING THEIR CHILD TO SUMMER SCHOOL OR CAMP DURING THE PANDEMIC
We’re a few days into the summer season and, with many restrictions being lifted amid the COVID-19 pandemic, summer school programs and camps have opened or will open soon. Children may be eager to play and interact with the other kids, but there will likely be changes at the schools and camps.
“Social interaction, engaging learning opportunities and physical activity are critically important for kids’ emotional and physical well-being. And high-quality child care outside of the home is essential for many families. We must work to get our kids back to these activities. While we figure out the best way to do this safely, there will be a lot of new routines and practices to follow,” says Katherine Connor, M.D., M.P.H., assistant professor of pediatrics at the Johns Hopkins University School of Medicine and medical director at the Ruth and Norman Rales Center for the Integration of Health and Education.
Some changes that children may experience include smaller groups at camps, maintaining 6 feet of distance from other children, frequent hand-washing and daily temperature checks. Connor says children and staff members should be checked for COVID-19 symptoms or exposure to the new coronavirus so they do not place others at risk.
“The health and safety routines schools and camps must put in place may be frightening or stressful for some kids,” Connor says. Parents can help prepare their children by learning about the routines ahead of time, explaining them and why they are needed in a developmentally appropriate way, and taking precautions like hand-washing at home. Pointing out how following these practices can help keep them and others safe is especially important since it gives kids a sense of control in uncertain times.
Connor and LaToya Mobley, M.S.W., Johns Hopkins Harriet Lane clinic social worker, are available to speak with media about what parents can do to prepare their children for camp or summer school amid a pandemic.
JOHNS HOPKINS HELPS LEAD CREATION OF NATIONAL COVID-19 DATABASE FOR ‘BIG DATA’ STUDIES
Big data is defined as extremely large amounts of information that is hard to analyze using traditional techniques because of the volume, the wide variety of types and sources, or the disparate means by which it was collected. Using special evaluative and investigative methods known as big data analytics, researchers can mine huge, seemingly unrelated datasets to uncover hidden patterns, correlations and insights.
Now, a nationwide collaboration of clinicians, informaticians and other biomedical researchers at 60 institutions — with Johns Hopkins Medicine’s Christopher Chute, Dr.PH., M.D., M.P.H., as its co-leader — has begun collecting and harmonizing hundreds of thousands of medical records from COVID-19 patients to extract data for a new, centralized and secure database that will feed big data studies of the disease.
The National COVID Cohort Collaborative (N3C) was officially announced June 15 by its funding agency, the National Institutes of Health’s National Center for Advancing Translational Sciences (NCATS).
It is hoped that by midsummer of this year, the NCATS N3C Data Enclave, as the highly secure repository is known, will contain clinical, laboratory and diagnostic information from the electronic health records (EHRs) of at least 1 million patients from across the United States — with some 300,000 of them testing positive for SARS-CoV-2, the virus that causes COVID-19. The data will be aggregated into a standard format so credentialed researchers and health care providers will have easy, rapid and free access to this valuable resource.
The goals of the N3C, according to NCATS, are to “(1) create a robust data pipeline to harmonize EHR data into a common data model; (2) make it fast and easy for the clinical and research community to access a wealth of COVID-19 clinical data, and use it to research COVID-19 and identify effective interventions as the pandemic continues to evolve; (3) establish a resource for the next five years to understand the long-term health impact of COVID-19; and (4) create a state-of-the-art analytics platform to enable novel analyses that will serve to address COVID-19, as well as demonstrate that this collaborative analytics approach could be invaluable for addressing other diseases in the future.”
Along with serving as the N3C’s co-lead, Chute, the Bloomberg Distinguished Professor of Health Informatics at the Johns Hopkins University School of Medicine and a faculty member at the university’s schools of public health and nursing coordinates a Johns Hopkins team developing software and a “transformation pipeline” to harmonize data from the participating N3C institutions into a common format. Additionally, Chute and his colleagues work on key N3C aspects such as data governance and analytics, and on protecting the rights and privacy of the patients from whom data are collected.
Chute is available for interviews about the N3C initiative and Johns Hopkins Medicine’s key role in the effort.
CELEBRATING INDEPENDENCE DAY SAFELY AMID A PANDEMIC
July Fourth is typically a day for fireworks and outdoor barbecues. However, the COVID-19 pandemic has changed the way Americans are honoring independence this year. Many celebrations across the country have been canceled or postponed due to restrictions on large gatherings.
If you plan to get together with friends, family members or loved ones, there are some precautions to consider. Lisa Maragakis, M.D., M.P.H., senior director of infection prevention for the Johns Hopkins Health System, recommends following current, local public health and safety guidance when hosting or attending a gathering this holiday. Limiting the size of the party, practicing physical distancing (at least 6 feet apart when possible) and wearing masks or other face coverings are important. If weather permits, Maragakis says outdoor parties are typically safer than indoor get-togethers, because the coronavirus that causes COVID-19 is more likely to be transmitted in enclosed spaces. Also, remember to always wash your hands with soap and water for at least 20 seconds before cooking, handling food or eating to help prevent spreading or contracting the coronavirus.
Maragakis is available for media interviews to provide recommendations for safely celebrating this Independence Day.
PANDEMIC RESOURCE ALLOCATION NEEDS TO ADDRESS HEALTH INEQUITY
If some regions become hot spots and hospitals reach maximum capacity during the COVID-19 pandemic, hospitals have plans for how to decide who gets critical care resources, such as a bed in the intensive care unit or a respirator. Many hospitals recommend distributing resources to the healthiest patients who are most likely to survive. However, Johns Hopkins Medicine physicians and bioethicists say that using this kind of selection method preferentially chooses people who are white or affluent over patients who are Black, Latino or from the inner city.
In a commentary published June 22 in The Lancet, the Johns Hopkins team provides recommendations for how hospitals can provide equitable care during pandemic resource allocation, such as by requiring regular bias training and creating periodic checkpoints to assess inequities in the system.
“Prejudice, institutional racism and redlining over generations has led to drastic health inequities in Baltimore and many other cities around the country, making these populations of people inherently sicker,” says Panagis Galiatsatos, M.D., M.H.S., assistant professor of medicine at the Johns Hopkins University School of Medicine. “We wanted to make sure that we developed a plan that ensures that resources are fairly distributed and that we weren’t contributing to existing inequalities. And we want to be able to share these guidelines to other hospitals so they can also be prepared to make humane decisions for their patient communities.”
The American College of Chest Physicians and the Society of Critical Care Medicine recommend using the sequential organ failure assessment (SOFA) to determine which patients are the healthiest and should get resources, based on factors such as whether the patient has health issues such as heart failure or diabetes. However, the aforementioned organization’s physicians say this model hasn’t been effectively evaluated for the COVID-19 pandemic. They also say that although the method works on entire populations, it hasn’t been tested on individual disadvantaged groups. And, because the criteria disproportionally affect minority groups and the poor, the researchers say, the proposed system need adjusting.
The first thing the team recommends is to have unconscious-bias training for the people in critical care medicine making the decisions about who gets resources.
Next, the team says hospitals need to periodically assess their survival numbers by income, race and other socioeconomic factors. Then, they must have an outside committee that includes community members to assess where there are weaknesses in the system and develop strategies to address these deficiencies. For example, some populations might need more time with a specific resource than affluent, white patients because people in the group may otherwise be more likely to die.
Galiatsatos is available to discuss how current resource allocation methods cast aside vulnerable populations. He can also talk about the methods his team suggests to address the inequities.
COVID-19 Pandemic Highlights Much Needed Improvements for Measuring Health Care Quality
Health care providers routinely collect and submit data to understand the quality of care they are delivering to patients. But what happens when a health care crisis strikes and the data are difficult to obtain? The COVID-19 pandemic has highlighted that quality measurement is labor intensive, that there’s a substantial time lag between care and reporting on the quality, and that standardizing data for purposes of data sharing is needed, according to experts from the Johns Hopkins Armstrong Institute for Patient Safety and Quality.
“Measuring the quality of care is essential during both times of stability and times of crisis,” says J. Matthew Austin, Ph.D., M.S., faculty member at the Armstrong Institute and assistant professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine. “During a crisis, health care is still being delivered, and the need to understand the quality and safety of that care becomes even more important as the care processes continue to rapidly change.”
“The COVID-19 crisis highlighted some of the important limitations and challenges of our current approach to quality measurement in the U.S.,” says Allen Kachalia, M.D., J.D., senior vice president of patient safety and quality for Johns Hopkins Medicine and director of the Armstrong Institute. “The health care system should prevent being in a situation with a poor understanding of the quality of health care being delivered, regardless of whether there is a public health crisis.”
Austin and Kachalia are available for interviews to discuss the strengths and weaknesses of quality measurement in the U.S. health care system, the impact of the pandemic on quality measurement and their recommendations for improvement.
LAB- GROWN 'MINI-BRAINS' SUGGEST COVID-19 VIRUS CAN INFECT HUMAN BRAIN CELLS
A multidisciplinary team from two Johns Hopkins University institutions, including neurotoxicologists and virologists from the Bloomberg School of Public Health and infectious disease specialists from the school of medicine, has found that organoids (tiny tissue cultures made from human cells that simulate whole organs) known as “mini-brains” can be infected by the SARS-CoV-2 virus that causes COVID-19.
Early reports from Wuhan, China, the origin of the COVID-19 pandemic, have suggested that 36% of patients with the disease show neurological symptoms, but it has been unclear whether or not the virus infects human brain cells. In their study, the Johns Hopkins researchers demonstrated that certain human neurons express a receptor, ACE2, which is the same one that the SARS-CoV-2 virus uses to enter the lungs. Therefore, they surmised, ACE2 also might provide access to the brain.
When the researchers introduced SARS-CoV-2 virus particles into a human mini-brain model, the team found — for what is believed to be the first time — evidence of infection by and replication of the pathogen.
The human brain is well-shielded against many viruses, bacteria and chemical agents by the blood-brain barrier, which in turn, often prevents infections of the brain. “Whether or not the SARS-CoV-2 virus passes this barrier has yet to be shown,” notes senior author Thomas Hartung, M.D., Ph.D., chair for evidence-based toxicology at the Bloomberg School of Public Health. “However, it is known that severe inflammations, such as those observed in COVID-19 patients, make the barrier disintegrate.”
The impermeability of the blood-brain barrier, he adds, also can present a problem for drug developers targeting the brain.
The impact of SARS-CoV-2 on the developing brain is another concern raised by the study. Previous research from Paris-Saclay University has shown that the virus crosses the placenta, and embryos lack the blood-brain barrier during early development. “To be very clear,” Hartung says, “we have no evidence that the virus produces developmental disorders.”
However, the mini-brains — which model the growing human brain — contain the ACE2 receptor from their earliest stages of development. Therefore, Hartung says, the findings suggest that extra caution should be taken during pregnancy.
“This study is another important step in our understanding of how infection leads to symptoms, and where we might tackle the COVID-19 disease with drug treatment,” says William Bishai, M.D., Ph.D., professor of medicine at the Johns Hopkins University School of Medicine, and leader of the infectious disease team for the study.
The human stem cell-derived mini-brain models — known as BrainSpheres — were developed at the Bloomberg School of Public Health four years ago. They were the first mass-produced, highly standardized organoids of their kind, and have been used to model a number of diseases, including infections by viruses such as Zika, dengue and HIV.
JOHNS HOPKINS MEDICINE LEADS EFFORT TO BRING COVID-19 TESTING TO HARD-HIT COMMUNITIES
COVID-19 has affected more than 2.5 million people around the U.S., and some areas have suffered from the disease far worse than others.
Johns Hopkins Medicine is leading an initiative to provide COVID-19 testing to hard-hit areas of Baltimore City that continue to report a significant number of cases. “We are working with the Baltimore City Health Department to identify areas with a significant amount of cases,” says Kathleen Page,M.D. associate professor at the Johns Hopkins University School of Medicine, who helped organize the testing effort. “Our goal is to test up to 150 people at each of our events to prevent further spread of the illness.”
The team’s first testing event took place on Thursday, June 25, at Sacred Heart of Jesus Church in East Baltimore, in the 21224 zip code, which was designated as a “hot spot” by the city health department. A total of 85 people were tested during the event. The neighborhood and parish have a largely Latinx population. Johns Hopkins Medicine experts say the Latinx community has seen a spike in cases locally and around the nation.
During the June 25 event, Johns Hopkins clinicians and staff set up a temporary testing site for the event in the church’s parking lot. The testing teams follow up with those tested within 24–48 hours to give them their test results, help them get appropriate care and share other resources.
The team plans to continue testing in Baltimore neighborhoods several days a week, and recommends community members schedule an appointment for testing. They also plan to move to other locations within the city and potentially beyond Baltimore as needed.
The initiative is in collaboration with the Maryland Department of Health, the Baltimore City Health Department and Baltimoreans United in Leadership Development (BUILD).
Pictures from the recent testing event are available upon request. Johns Hopkins Medicine experts are also available for media interviews on Johns Hopkins’ community testing initiative.
For information from Johns Hopkins Medicine about the coronavirus pandemic, visit hopkinsmedicine.org/coronavirus. For information on the coronavirus from throughout the Johns Hopkins enterprise, including the Johns Hopkins Bloomberg School of Public Health and The Johns Hopkins University, visit coronavirus.jhu.edu.