One year ago, then 65-year-old Miriam Clark developed a fever, lost her appetite and had no energy. She and her daughter, Tye Clark, the administrative services manager of the Johns Hopkins University School of Medicine Division of Hospital Medicine, never could have imagined what they would end up going through before Miriam was diagnosed with COVID-19. Looking back on the year, the mother and daughter duo are thankful and now even have reason to celebrate.
In late March 2020, Miriam, who lives in New Jersey, thought she had the flu. Her fever didn’t go away after 10 days, and she soon developed a cough. She was unable to get tested for COVID-19, and her symptoms were deteriorating, causing her to have difficulty breathing. Her daughter, Tye, turned to her colleague Daniel Brotman, M.D., director of the Division of Hospital Medicine, who told Tye to rush her mom to the hospital immediately. He instructed Tye to properly don personal protective gear to keep herself and her mother safe before the six-hour round-trip journey to pick up her mom and bring her back to Baltimore to receive care at The Johns Hopkins Hospital. Once there, Miriam, who could barely walk due to her declining condition, was diagnosed with COVID-19. She required additional oxygen and remained in the hospital for 10 days.
At the end of May 2020, Miriam says she began feeling 100% better. She is now back at work full time and maintains a 25-minute daily workout routine that includes jogging or walking, lifting weights and situps.
Miriam is currently participating in a clinical trial at Johns Hopkins to help further research on COVID-19, particularly its effect on the heart. She also made it a priority to get the COVID-19 vaccine. “It was a no-brainer,” she says. “When I think back a year ago, I don’t ever want to be back in that situation. Anything I can do to prevent that situation, I will do it.” Tye is also planning to get the vaccine.
In April, Tye will be getting married in a small ceremony with 10 people in attendance following the guidance of the Centers for Disease Control and Prevention. Both she and Miriam are glad that Miriam is able to attend. “I have a lot to be grateful for in the midst of the pandemic,” Tye says.
“I was one of the lucky ones,” Miriam says.
Miriam and Tye, as well as Miriam’s physicians, are available to speak with media. To learn more about their experience, please watch a video of Tye and Miriam retelling their story.
SHIRLEE WOHL, PH.D., WHAT IS A VIRAL VARIANT ANYWAY?
Shirlee Wohl, Ph.D., postdoctoral researcher at the Johns Hopkins Bloomberg School of Public Health, explains how viral variants are identified, why her work tracking them is so important and what new types of SARS-CoV-2 could mean for the end of the pandemic.
“The one thing people ask me most is should I be more scared?” says Wohl. “Instead, I suggest that new, more infectious COVID-19 variants make the safety measures we already are taking even more important.”
Wohl is available for interviews on this topic.
When clinical trials were conducted to determine the immunogenicity — the ability to elicit an immune response — for the first two vaccines marshaled against SARS-CoV-2, the virus that causes COVID-19, one group was not among those included: people who have received solid organ transplants and others (such as those with autoimmune disorders) who are immunocompromised.
Now, Johns Hopkins Medicine researchers have tried to rectify that inequity, taking one of the first looks at how people who are immunocompromised respond to their first dose of one of the two mRNA vaccines — Moderna and Pfizer-BioNTech — currently being administered worldwide. Their findings, as published March 15, 2021, in a research letter in the Journal of the American Medical Association, disappointingly show that only 17% produced detectable antibodies against the SARS-CoV-2 virus.
“This is in stark contrast to people with healthy immune systems who are vaccinated, nearly all of whom mount a sufficient antibody defense against COVID-19,” says study lead author Brian Boyarsky, M.D., a surgery resident at the Johns Hopkins University School of Medicine.
The study evaluated the vaccine immunogenic response for 436 transplant recipients, none of whom had a prior diagnosis of COVID-19 or tested positively for SARS-CoV-2 antibodies. The median age was 55.9 years and 61% were women. Fifty-two percent were administered a single dose of the Pfizer-BioNTech vaccine and 48% received one shot of the Moderna vaccine. The median time since transplant for the participants was 6.2 years.
At a median time of 20 days after the first dose of vaccine, the researchers report that only 76 of the 436 participants (17%) had detectable antibodies to the SARS-CoV-2 virus. The researchers also found that among the 76 transplant recipients, the most likely to develop an antibody response were those younger than age 60 who did not take anti-metabolites for immunosuppression and who received the Moderna vaccine.
“Given these observations, we feel that the U.S. Centers for Disease Control and Prevention should update their new guidelines for vaccinated individuals to warn immunocompromised people that they still may be susceptible to COVID-19 after vaccination,” says study senior author Dorry Segev, M.D., Ph.D., the Marjory K. and Thomas Pozefsky Professor of Surgery and Epidemiology and director of the Epidemiology Research Group in Organ Transplantation at the Johns Hopkins University School of Medicine. “As the guidelines are currently written, people assume that vaccination means immunity.”
Segev says that upcoming studies will define the immunogenic response of organ transplant recipients and other immunocompromised patients after a second vaccine dose. Other studies will look at the impact of more extensive immune system profiling — including characterizing the immune cells that remember SARS-CoV-2 after vaccination and produce antibodies, or directly attack the virus in response to the presence of the virus — to help guide vaccination strategies for this population.
Boyarsky and Segev are 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.