HOW TO CELEBRATE THANKSGIVING SAFELY THIS YEAR
For many of us, this year’s holiday season may look different, and many are asking how we can enjoy the fellowship of the season while keeping ourselves, our loved ones and our communities safe from COVID-19.
Johns Hopkins Medicine experts urge people to make responsible, safe decisions as they develop their Thanksgiving plans this year. This includes wearing masks, practicing physical distancing and staying at home whenever possible.
“We’ve had to make some challenging decisions on how we celebrate the festivities over the next several weeks,” says Sapna Kudchadkar, M.D., Ph.D., associate professor of anesthesiology and critical care medicine. “We’ve decided as a family that it’s really important that we make this sacrifice this year and celebrate at home. We’ll be using video calls creatively so we can all celebrate safely without missing out on the most important parts of the holidays.”
Johns Hopkins Medicine experts are available for interviews about safe holiday celebrations.
More information from Johns Hopkins on celebrating the holidays safely: How To Make Decisions About Winter Holiday Gatherings Amid COVID-19.
FEAR AMONG UNDOCUMENTED LATINOS GOES BEYOND COVID-19
The COVID-19 pandemic has not only exacerbated and exposed long-standing health and social inequities in the Latino community, it has also caused additional fear, mistrust and concern, especially among undocumented people. More than catching the virus itself, undocumented Latinos fear job loss, eviction and deportation.
According to Kathleen Page, M.D., associate professor of medicine at the Johns Hopkins University School of Medicine, fear has been one of the main drivers for Latinos in delaying or not seeking medical attention during the pandemic. “Language barriers, misinformation, the need to work, anti-immigrant policies and limited access to care have fueled this fear,” says Page.
Through months of working with the Latino community in Baltimore, her experiences serve as lessons to help battle misinformation and rebuild trust. She says bridging the language gap is crucial. Page and other colleagues established Juntos, a team of bilingual volunteer nurses, physicians and social workers who meet with Latino patients and families. “Spanish-speaking patients felt they could open up to us and relayed their fears because we spoke their language,” says Page. This initiative led to Juntos Contra COVID-19 (“Together Against COVID-19”), a Johns Hopkins Medicine public health campaign to educate the Latino community about the impact and seriousness of COVID-19, and the creation of a Spanish-language COVID-19 resources web portal.
However, language barriers aren’t the only obstacle. Even as testing became more available, Latinos aren’t getting tested as they fear that a positive result could lead to job loss, and they worry about the high cost of care. “Patients were relieved when we told them their care was covered through the Coronavirus Aid, Relief and Economic Security (CARES) Act, and we learned the importance of providing this information,” says Page. She also stresses the importance of hospitals and academic institutions encouraging undocumented immigrants to seek care by clearly communicating that health care workers don’t cooperate with immigration authorities.
Page, who is available for interviews, dives into the challenges that undocumented Latinos have faced during the pandemic and the lessons learned in a perspective article published Oct. 7 in the New England Journal of Medicine.
YOUNGEST COVID-19 PATIENTS MOST LIKELY TO AVOID SEVERE ILLNESS, RECOVER WITH CARE
In a comprehensive review of research studies looking at infections from SARS-CoV-2 — the virus that causes COVID-19 — in infants less than 3 months old, Johns Hopkins Medicine researchers found that the majority of these tiny patients experience mild to moderate cases of the disease and usually recover with supportive care.
According to the U.S. Centers for Disease Control and Prevention (CDC), children ages 0 to 4 years were the population least impacted by COVID-19 between Jan. 21 and Oct. 15, 2020, both in number of cases (98,216 or 1.7%) and deaths (34 or less than 0.1%). The counts and percentages were calculated from CDC’s totals for that time span of nearly 6 million cases and greater than 155,000 deaths in the United States for which age-specific data were available.
Nonetheless, the youngest members of that group — infants less than 3 months old — have still-developing immune systems and frequently come in close contact with their caretakers. This makes them disproportionally vulnerable to infection with the SARS-CoV-2 virus compared with older infants and other young children.
To more accurately assess the virus’ impact on very young infants, the Johns Hopkins Medicine team conducted a systemic review of reports and studies published between Nov. 1, 2019, and June 15, 2020, on laboratory-confirmed community-onset (where symptoms are first seen outside of the hospital) SARS-CoV-2 infections in children less than 3 months of age. Thirty-eight publications describing 63 infants met the criteria for being included in the study.
The researchers used data from the documents to define several variables about the youngest group infected by SARS-CoV-2, including age, exposure to COVID-19, past medical history, clinical symptoms, SARS-CoV-2 testing, laboratory findings, clinical course, and resulting outcome after hospital discharge or end of care (disposition).
Most of the infants evaluated in the study — 58 out of 63, or 92% — were hospitalized upon confirmation of SARS-CoV-2 infection. Along with the most common characteristic, fever (46, or 73%), the patients presented with various degrees of respiratory, gastrointestinal, cardiac and neurological symptoms. Eventually, most of the cases proved mild to moderate and improved with supportive care. Three infants were asymptomatic. Of the 63 patients, only 13 (21%) were admitted to an intensive care unit and two (3%) required invasive mechanical ventilation. No deaths were reported.
“Our results demonstrate a need for physicians to suspect SARS-CoV-2 infection in young infants presenting with generalized symptoms, such as fever or decreased desire to feed, even in the absence of respiratory problems,” says Johns Hopkins Children’s Center pediatrician Julia Johnson, M.D., Ph.D., associate director of clinical research in the Division of Neonatology and assistant professor of pediatrics at the Johns Hopkins University School of Medicine. “Further studies of SARS-CoV-2 infection in this special population are needed to address unanswered questions about how infants acquire the virus and what impacts it may have on their future health.”
AUTOPSIED HEARTS SHOW MYOCARDITIS LINK TO COVID-19 RARER THAN PREVIOUSLY BELIEVED
The suspected link between the SARS-CoV-2 virus — the cause of the COVID-19 pandemic — and myocarditis, an inflammation of the heart muscle (myocardium), made news this past August when a German research study claimed that 60 out of 100 patients who had recovered from the coronavirus showed signs of the dangerous heart condition via MRI. Shortly after that announcement, stories arose about several athletes with possible COVID-19-related myocarditis — including major league pitcher Eduardo Rodriguez, who was sidelined for the entire 2020 season — that appeared to support the connection.
However, following a recent review of clinical findings from 277 hearts autopsied from people in nine countries who died from COVID-19, researchers at Johns Hopkins Medicine and the Louisiana State University Health Sciences Center, New Orleans suggest otherwise, saying their evaluation provides evidence that myocarditis related to the viral disease may actually be a rare occurrence.
The data from the autopsied hearts were published in 22 papers. After careful review, the researchers determined that the rate of myocarditis found in these patients is between 1.4% and 7.2%. Earlier studies, using imaging of hearts rather than a physical examination of the organs following death, reported rates ranging between 14% and 60%.
“What we have learned is that myocarditis is not nearly as frequent in COVID-19 as has been thought,” says Marc Halushka, M.D., Ph.D., professor of pathology at the Johns Hopkins University School of Medicine and one of two study authors. “This finding should be useful for our clinical colleagues when considering how to best interpret blood tests and heart radiology studies.”
“By bringing the data together from this large number of autopsy cases, we have better defined the spectrum of histologic findings that can be seen in the hearts of people with COVID-19,” adds co-author Richard Vander Heide, M.D., Ph.D., M.B.A., professor of pathology at the LSU Health New Orleans School of Medicine.
The researchers say that even a low myocarditis rate of 1.4% would predict hundreds of thousands of worldwide cases of myocarditis following severe COVID-19. Low rates of myocarditis, they add, do not indicate that individuals infected with SARS-CoV-2 are not having cardiovascular problems, but rather those complications are likely due to other factors such as immune responses or electrolyte imbalances.
Based on the results of their study, the researchers have created a checklist for pathologists to use when evaluating COVID-19 at autopsy to provide consistency in investigating and reporting cardiovascular pathologic findings.
“This study demonstrates the importance of the autopsy in helping us determine what is occurring in the hearts of individuals passing away due to COVID-19,” says Halushka.
JOHNS HOPKINS MEDICINE CONDUCTING CLINICAL TRIAL OF COVID-19 THERAPIES FOR OUTPATIENTS
In the battle against COVID-19, clinical trials enable researchers and clinicians to field test the weapons they hope will help end the current pandemic and prevent more from occurring. Trials to evaluate therapies for COVID-19 outpatients — those people diagnosed with cases of the disease not severe enough to require hospitalization — are now being conducted under the Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV-2) program. The program is part of Operation Warp Speed, the federal government’s COVID-19 treatment development effort led by the National Institutes of Health’s National Institute for Allergies and Infectious Diseases.
Johns Hopkins Medicine is one of more than 50 clinical trial sites across the United States for ACTIV-2, which plans to test several investigational medicines to see if they are safe and effective against COVID-19 in outpatients with mild to moderate symptoms. The ultimate goal is to develop treatments that can stop the disease from worsening so that people don’t have to go to the hospital.
Participants in the trial must be adults ages 18 and older who have tested positive for COVID-19 within the previous seven days and have been at home with mild to moderate symptoms. Each person will be randomly placed into either a group that will receive the drug under study or one that will get a placebo. Patients will be followed for six months.
“The first drug we are testing is the monoclonal antibody LY-CoV555 (also known as LY3819253) which keeps SARS-CoV-2 [the virus that causes COVID-19] from binding to the cells it targets for attack,” says Kelly Dooley, M.D., Ph.D., associate professor of medicine at the Johns Hopkins University School of Medicine and one of the leaders of the Johns Hopkins Medicine ACTIV-2 program. “LY-CoV555 was copied from an antibody isolated in the blood of a patient who recovered from COVID-19. Preliminary evidence from earlier trials suggests that it could be effective at reducing the duration of symptoms and the amount of virus being shed by patients, both of which could mean fewer hospitalizations.”
The hardest part of conducting the ACTIV-2 trial at Johns Hopkins Medicine and other testing centers, say the researchers involved, may be recruitment.
“Outpatients with milder cases of COVID-19 are likely to believe that clinical trials are only for seriously ill patients who have no other treatment options, so they probably don’t think of themselves as candidates,” says Mark Sulkowski, M.D., professor of medicine at the Johns Hopkins University School of Medicine and chief of the infectious diseases division at Johns Hopkins Bayview Medical Center, where the ACTIV-2 trial is being conducted. He also serves as the director of the COVID-19 Clinical Research Center within the Johns Hopkins Institute for Clinical and Translational Research.
“However, a clinical trial to get effective therapies into practice for outpatients may actually be more critical toward curtailing the spread of COVID-19, because they’re the ones, not hospitalized patients, who are likely to pass the virus to others,” Sulkowski adds. “Furthermore, these treatments have the potential to reduce the risk of serious illness and hospitalization due to COVID-19.”
COVID-19 outpatients who enroll in the ACTIV-2 trial will be examined and treated within portable isolation rooms separated from the other facilities at Johns Hopkins Bayview. These clinical research units (CRUs) are steel-walled storage containers that have been converted into medical stations complete with self-contained air conditioning and heating, negative air pressure exhaust and virus-trapping filters; standard hospital electrical and lighting systems; Wi-Fi; emergency backup power and easily sanitized surfaces.
“The CRUs enable us to take care of participants with coronavirus safely and comfortably — giving them intravenous medications, performing virus detection tests and carrying out the procedures required to make ACTIV-2 successful — while keeping them separated from others,” says Dooley.
“We really are grateful for the volunteers who are willing to sign up for clinical trials, even while feeling ill,” she adds. “It is only with their help that we will develop the safe, effective outpatient treatments so desperately needed.”
For more information on the ACTIV-2 outpatient clinical trial, go to riseabovecovid.org/en.
Johns Hopkins Medicine researchers are working tirelessly to find ways to better understand and eventually eliminate COVID-19 and the virus that causes it. New discoveries, especially those related to clinical therapies and drug regimens, are still early in concept and small in sample size. Rigorous research, testing and peer review, all of which take time, will be required before solid conclusions for clinical care and disease prevention can be made.
NEW CENTER DEEPLY EXPLORES THE IMMUNOLOGY OF COVID-19
The Johns Hopkins University School of Medicine and the Johns Hopkins Bloomberg School of Public Health have announced a new center for intensely studying the immune response to SARS-CoV-2 — the virus that causes COVID-19 — to improve serological tests for the pathogen. The goal is to provide a deeper understanding of the mechanisms by which the virus impacts the immune system in order to facilitate development of effective treatments and vaccines against it.
The joint research project, known as the Johns Hopkins Excellence in Pathogenesis and Immunity Center for SARS-CoV-2 (JH-EPICS), was established under a five-year grant from the National Cancer Institute (NCI), part of the National Institutes of Health. The funding of more than $2 million per year will support studies — commencing immediately — of the immune elements that determine whether people get mild or severe COVID-19 illness following exposure to the virus.
The center will be jointly led by Andrea Cox, M.D., Ph.D., professor of medicine at the Johns Hopkins University School of Medicine, and Sabra Klein, Ph.D., professor of molecular microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health.
“A lot of researchers have been studying COVID-19 on the side, but with a center grant like this, we can support a full-time focus on it by multiple investigators working as a team, and that gives us a good chance to solve some of the outstanding mysteries about this disease,” Cox says.
“Our new center’s goal is to combine Johns Hopkins’ world-class expertise in immunology, virology and biostatistics to map out the complexity of the immune response as it develops after infection — and to understand why that response can differ so greatly depending on age, gender, race, comorbidities such as obesity, and other factors,” Klein says.
Research at the center will focus on several immunological aspects of the novel coronavirus and COVID-19, including antibody- and cell-driven immunity, immune genetics, autoimmunity, molecular virology and other relevant fields.
The center’s researchers will be able to draw upon the clinical resources of Johns Hopkins Medicine, including thousands of blood samples taken from COVID-19 patients at all stages of infection. Additionally, the advanced quantitative techniques of computational biologists and biostatisticians at the Bloomberg School will help define meaningful patterns from enormous amounts of data.
The NCI funding for the project comes from an emergency $306 million appropriation by Congress earlier this year to create the Serological Sciences Network for COVID-19 (SeroNet). SeroNet is establishing eight Serological Sciences Centers of Excellence around the United States, of which JH-EPICS is one.
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.