Story Tips From Johns Hopkins Experts on COVID-19

Johns Hopkins Medicine

Newswise — A Nurse Becomes a Patient While Battling COVID-19 at Johns Hopkins

Sharon Tapp, who worked as a nurse case manager at Veterans Affairs Medical Center in Washington, D.C., started experiencing sudden body weakness, chest pain, a high temperature and headache on March 18. Concerned, she went to her local urgent care center to find out what was wrong. They told her that these symptoms were flu-like, tested her for the coronavirus and told her to quarantine for 14 days. After five days and no difference in the presentation of her symptoms, the urgent care team contacted Sharon, letting her know that she tested positive for coronavirus and recommending that she go to the emergency department. Sharon’s family took her to Johns Hopkins Medicine’s Suburban Hospital. Because her condition worsened while at Suburban, she was transferred to The Johns Hopkins Hospital in Baltimore within 10 days of being admitted to Suburban Hospital.

While being cared for at Johns Hopkins, Sharon spent two months in a medically induced coma. Throughout her 117-day stay, Sharon spent time in the medical intensive care and cardiac care units, where she was also placed on a ventilator while battling pneumonia and heart and lung failure. She received dialysis as well as a procedure called extracorporeal membrane oxygenation (ECMO), which is a treatment that helps to oxygenate and recirculate blood throughout a person’s body, allowing vital organs to rest and heal.

Today, Sharon is still receiving care in the hospital, including targeted rehabilitation therapy from a multidisciplinary team in the Johns Hopkins physical medicine and rehabilitation department to aid in her cognitive, physical and verbal recovery. Her daily care routine includes muscle strengthening exercises to improve her weakness and regular in-hospital walks to improve her strength and balance. She is slowly regaining her independence with activities of daily living such as standing, walking, lifting and reaching for items. In addition, her speech therapy providers are working on her swallowing function and her cognitive-linguistic ability. It has been a long road to recovery for Sharon. She, her family and her care team are hoping she will be ready for discharge on July 17.

Sharon says the care she received from her Johns Hopkins providers and her family and friends’ daily phone calls and prayers are what guided her through such an uncertain journey.

Tapp and April Pruski, M.D., a member of Tapp’s care team and assistant professor at the Johns Hopkins University School of Medicine, are available for media interviews.

 

Fraudulent Cards Mask Real Danger of Not Wearing Face Coverings

Wearing a mask has been promoted by public health experts across the world as one of the simplest and most effective ways to slow the spread of COVID-19. However, some people who refuse to wear masks have taken to carrying a fraudulent card that claims they are exempt from covering their faces in public.

The card, circulating online from the fictitious Freedom to Breathe Agency, claims the holder will incur mental or physical risk by wearing a mask. The card also alleges the federal Americans with Disabilities Act (ADA) forbids a business from asking the holder why they are not wearing a mask, which may result in fines.

The U.S. Department of Justice distributed an alert warning the public about the fraudulent cards and urging them to check the ADA’s website.

The online hoax comes as most of the United States is experiencing a record number of COVID-19 cases, a surge that occurred when many jurisdictions relaxed physical distancing restrictions.

Johns Hopkins Medicine recently released an updated infographic about how to properly wear a face mask. Our experts also recommend staying home as much as possible and reducing visitors; encourage washing hands frequently with soap and water for at least 20 seconds; and provide guidance on what’s safe to do – and what to avoid – when going outside the home.

Gabor Kelen, M.D., director of the Department of Emergency Medicine, and Lisa Maragakis, M.D., M.P.H, senior director of infection prevention at Johns Hopkins are available to discuss this topic with media.

 

Effectively Communicating with Older Adults Who Have Hearing Loss During COVID-19

The COVID-19 pandemic has caused a variety of challenges for older adults with hearing trouble across different health care settings, including the inpatient hospital setting and nursing homes, assisted living facilities and home environments. Research from Johns Hopkins suggests that nearly half of adults over age 60 have hearing loss, which indicates a significant portion of the population may be experiencing these challenges as a result of COVID-19. 

During the COVID-19 pandemic, those with hearing difficulties who are accustomed to reading lips may face challenges because they cannot read the lips of people wearing a face mask. Additionally, following the 6 foot physical distancing recommendation can make communicating by sign language more difficult. To address these communication barriers, Johns Hopkins researchers have developed a checklist for clinicians to use while treating patients with hearing loss. Published online in the June 17, 2020, issue of the Journal of the American Geriatrics Society, the checklist provides recommendations for both inpatient and telehealth visits, such as using hand-held devices and telephones that enable the older adult to see and hear the provider clearly. The checklist also includes tips for the patient’s environment, including decreasing background noise, improving lighting, and ensuring providers effectively communicate via verbal and nonverbal ways such as speaking slowly or wearing a clear mask when permissible.

Nicholas Reed, Au.D., assistant professor of audiology in the Department of Otolaryngology–Head and Neck Surgery at the Johns Hopkins University School of Medicine, and of epidemiology at the Johns Hopkins Bloomberg School of Public Health, is available for comment.

 

Addressing Hearing Loss Checklist

Technological Considerations

Hand-held Amplification: With simple hand-held devices such as the Pocket Talker or SuperEar (Sonic Technology Products), standard headphones easily amplify sound with volume control to improve communication.

Amplified and Captioned Telephones: These telephones, specially designed for people with hearing loss, provide increased amplification and captioned conversation.

In-room Videoconferencing: Using video technology to communicate with patients may seem like it would pose barriers. However, it allows providers to speak clearly and show their mouth for lip reading. In addition, frequencies important for speech can be amplified, and speech can be used to text to caption the video in real time. 

Speech to Text: Speech-to-test applications, such as software by Google, are increasingly available. These apps can provide live transcription of conversation to assist those with hearing loss. 

Smartphone Amplification: Apps such as Google Sound Amplifier offer high quality noise reduction algorithms and amplification for personal smartphones. These may be an option when hand-held amplifiers aren’t available.

 

Environmental Modifications

Lessen Background Noise: Reducing background noise by turning down the television and closing the door to noisy areas can improve communication.

Improve Room Lighting: Proper lighting helps people with hearing loss visualize the speaker to aid in lip reading, but overwhelming lighting (such as a window reflection) can be distracting.

Placards: Placards with phrases, questions and comments commonly used during a hospital stay or outpatient visit can be helpful. Using a large font with high contrast color can further help older adults.

Whiteboards or Tablets: Using whiteboards or tablets to write conversation can be cumbersome, but they are last resort options.

 

Communication Considerations

Ensure Attention: Communication requires both parties to be attentive.

Communicate Face to Face: Ensuring that the listener can see your face to lip-read is important. It also directs sound at the listener rather than in another direction. This means looking up from charts and away from computers when possible.

Make the Provider’s Mouth Visible When Possible: Covering the mouth area is a must to help prevent spread of the virus that causes COVID-19. However, any opportunity possible to use clear masks or videoconferencing without masks can help people who consciously and subconsciously lip-read.

Speak Slowly and Low: Age-related hearing loss generally occurs in higher frequencies and limits the clarity of speech. Slowing down and using a slightly lower tone can help listeners with hearing loss follow the conversation.

Do Not Shout: Most age-related hearing loss is an issue of clarity rather than volume. While some increased volume helps, shouting often further distorts information.

Give Context to Conversation: Placing the conversation in context helps the listener decipher meaning and fill in the gaps when words are difficult to hear. This means adding supporting information such as common descriptions or actions, and being redundant.

Rephrase Rather Than Repeat: Rephrasing, and using words that are easier to hear can help the listener gain new context about the conversation. Repeating can create a frustrating negative-feedback loop.

 

Universal Testing May Help Reduce COVID-19 Infections, Deaths in Long-Term Care Facilities

Throughout the COVID-19 pandemic, residents in long-term care facilities — including nursing homes and assisted living centers — have been at particularly high risk of infection by and spread of SARS-CoV-2 (the virus that causes COVID-19), and with a disproportionally tragic outcome. According to estimates in an article in The New York Times, although only 10% of COVID-19 cases in the United States have occurred in long-term care facilities, they are responsible for 42% of deaths from the disease.

However, a team of infectious disease experts at Johns Hopkins Medicine believes the actual number of COVID-19 infections nationally in long-term care facilities may be much higher because health care providers are missing asymptomatic cases. This discrepancy, they warn in a new study published July 14 in JAMA Internal Medicine, may make it more difficult to reduce or prevent the spread of COVID-19 in the very susceptible population living in these centers.

In their study, the researchers performed “universal testing” for SARS-CoV-2 among all 893 men and women living at 11 long-term care facilities in Maryland. Previously, only residents who showed symptoms of COVID-19 had been “target tested” by local health departments.

Among the 893 universally tested, 354 people — nearly 40% —were found to be positive for SARS-CoV-2 RNA, compared with 153 (17%) identified in earlier target testing based on symptoms. The universal screening, therefore, raised the number of COVID-19 cases among the residents in the state’s long-term care facilities from 153 to 507 (57%), a 231% increase. Of those who tested positive, the researchers report that 281 (55%) were asymptomatic.

“These results underscore the importance of universal testing, as symptom-based approaches may miss a substantial number of cases in long-term care facilities,” says Benjamin Bigelow, a fourth-year medical student at the Johns Hopkins University School of Medicine and the study’s lead author. “Unrecognized asymptomatic cases among residents can severely hinder preventive strategies and increase the risk of the virus dangerously spreading.”

“More testing resources are urgently needed to identify the true burden of COVID-19 in long-term care facilities, so that we can be more successful in curbing infection and mortality in one of the disease’s major hot spots,” adds Morgan Katz, M.D., M.H.S., assistant professor of medicine at the Johns Hopkins University School of Medicine and senior author of the study.

 

Study Says Twitter Effectively Communicates Pediatric Critical Care Info During a Pandemic

Ever since the microblogging and social networking platform Twitter emerged in 2006, it has consistently ranked among the top ways that people around the world communicate with one another, with some 500 million tweets sent per day. According to the Twitter monitoring company, Tweet Binder, the COVID-19 pandemic has dominated the Twitterverse with about 600 million tweets alone using the hashtag #COVID19, #coronavirus or something similar between February and May of this year.

Among the massive volume of COVID-19 tweets posted during that time were ones teamed with a second hashtag, #PedsICU — a social media designation created long before the pandemic to foster international collaboration, rapidly disseminate information and keep the lines of professional communication flowing among members of the pediatric critical care community. How effectively this hashtag twinning actually “spreads the word” about COVID-19 to those serving in pediatric intensive care units (PICUs) worldwide is the subject of a recent study posted online May 27 in the journal Pediatric Critical Care Medicine.

“We wanted to determine if leveraging social media, specifically Twitter, was a solid strategy for keeping PICUs across the globe connected and informed on the most current information during a pandemic,” says Sapna Kudchadkar, M.D., Ph.D., associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine and co-investigator for the study.

To conduct their study, Kudchadkar and co-investigator Christopher Carroll, M.D., M.S., research director of pediatric critical care at the Connecticut Children’s Medical Center, collected data on all tweets posted worldwide from Feb. 1 to May 2 that contained the hashtag #PedsICU, along with those containing both #PedsICU and a recognizable COVID-19 hashtag.

During that span, there were 49,865 #PedsICU tweets, with 21,538 (43%) of them also including a COVID-19 hashtag. Of the latter, #COVID19 was the most commonly used pandemic-related tag (69%). Geographic distribution for tweeters using the tandem hashtags spanned six continents, with the majority of tweets coming from North America and Australia.

There was a sharp rise in tweets with both hashtags around mid-March, which coincided with the World Health Organization raising COVID-19 to pandemic status. Since then, more than two-thirds of #PedsICU tweets were about the disease. About a third of the tweeters were physicians, but the researchers note there also was “robust engagement” from other PICU team members, including nurses, nurse practitioners, respiratory therapists and pharmacists.

One example of social media quickly disseminating COVID-19 news globally occurred April 26, when clinicians in the United Kingdom first recognized multisystem inflammatory syndrome in children (MIS-C) was potentially related to COVID-19. Tweets on this announcement with the hashtags #PedsICU and #COVID19 received some 3,500 shares within a few hours of the initial post.

The most popular tweets during the study period, the researchers say, were links to medical literature, reviews, educational videos and other open-access resources.

“Our study demonstrates that during a pandemic such as COVID-19, targeted use of #PedsICU combined with a specific disease-related hashtag significantly helps combat misinformation, quickly spreads useful data and news, and optimizes the reach of pediatric critical care stakeholders to others around the world,” says Kudchadkar, who is available for interviews.

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.

 

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