Story Tips from Johns Hopkins Experts on COVID-19

NEWS STORIES IN THIS ISSUE:

• Physician and Musician: Johns Hopkins Doctor Brings Passion for Music to Medicine During Pandemic
• Rapid, At-Home Blood Test Could Confirm COVID-19 Vaccination in Minutes
• What to Expect and Prepare for As You Return to Regular Health Care Appointments
• Study Suggests Sudden Hearing Loss Not Associated with COVID-19 Vaccination
• Vaccination May Not Rid COVID-19 Risk for Those with Rheumatic, Musculoskeletal Diseases
  

PHYSICIAN AND MUSICIAN: JOHNS HOPKINS DOCTOR BRINGS PASSION FOR MUSIC TO MEDICINE DURING PANDEMIC

Since the start of the pandemic, Johns Hopkins Hospital pulmonologist Brian Garibaldi, M.D., has cared for about 150 patients with COVID-19, including former President Donald Trump and many patients in the intensive care unit, and has led important research to find lifesaving treatments for COVID-19. Just like many health care professionals, Garibaldi, the medical director of the Johns Hopkins Biocontainment Unit, has felt the stress of providing care to patients suffering from a new, and often deadly, disease.

“Being on the front lines has been the most important part of my career,” Garibaldi says.

To help him cope with the stressors of the pandemic and support his overall well-being, Garibaldi has tapped a favorite hobby: making music. Garibaldi has played guitar since the sixth grade and has been a member of bands that played rock, pop and blues. Before attending medical school, he also spent a year studying flamenco guitar in Spain.

“It was an amazing experience, but I didn’t see myself as a professional musician,” he says. “I’ve always been more drawn to the medical field and patient care.”

Throughout his career as a physician, Garibaldi has continued to perform music — from his own compositions to classical guitar favorites and acoustic rock covers — at weddings or other events about two times a year. Garibaldi, who keeps a guitar in his office, has also used music as a way to connect with patients, particularly those who enjoy music or play themselves.

“Hospitals can be stressful,” Garibaldi says. “Patients can be going through challenging times, and being able to have normalcy while they are in the hospital is often helpful.”

In early 2020, as COVID-19 was beginning to spread worldwide, Garibaldi helped create protocols and best practices at Johns Hopkins, including the proper personal protective equipment needed for staff. That March, he oversaw the treatment of the first patients with the disease. He has published at least 20 peer-reviewed papers on COVID-19 that have helped inform clinical decisions about how health care providers safely care for patients, such as studying remdesivir, an antiviral medication originally developed to treat hepatitis C and tocilizumab, a medicine to treat inflammatory conditions like rheumatoid arthritis, as treatments for COVID-19 and risk factors, such as older age and obesity, for severe disease and death from COVID-19.

Through it all, music has been his therapy, whether jamming out in his makeshift home studio or writing and composing songs.

“There’s been a lot of uncertainty and concern about what’s been happening around the world and being in constant crisis mode,” Garibaldi says. “It’s one of the few things that I do where I can completely shut my mind off. It’s been incredibly relaxing to take five minutes to do something I love.”

Garibaldi was recently inspired to write a guitar piece to accompany a poem called When the Dust Settles, by Robin Lewis-Cherry, a nurse manager at The Johns Hopkins Hospital, as a reflection on the challenges and lessons from living and working through the pandemic.

“Music has been the main thing that has kept me sane,” Garibaldi says. Loved ones “can tell if I haven’t played music for a while, because I get irritable.”

Garibaldi is available for interviews on his passions for medicine and music, creating and playing songs as therapy during the pandemic, and how it has helped him connect with patients.

Listen to additional music compositions by Garibaldi.

RAPID, AT-HOME BLOOD TEST COULD CONFIRM COVID-19 VACCINATION IN MINUTES

One challenge as society reopens is identifying who has been vaccinated for SARS-CoV-2, the virus that causes COVID-19. A team of Johns Hopkins researchers has developed a rapid blood test that could confirm a person has been vaccinated while they wait to board a plane or enter a sporting event.

Their COVID-19 antibody test is similar to one used at home to determine blood type, where the user pricks a finger and places a drop of blood on a card. A fusion protein developed by the research team is housed on the card and detects COVID-19 antibodies, tiny proteins in the blood the immune system produces to “remember” viral encounters and provide immunity to future infections. Results come back in less than five minutes, faster than current lateral flow tests to detect antibodies at point of care, while also potentially providing a clearer result.

Robert Kruse, M.D., Ph.D., who created the blood test, says it could be used to confirm a person’s vaccination instead of having to show a vaccine card.

“If a business is using the honor system for vaccinations, now they could test people on-site,” he says.

Kruse is lead author of a paper posted online earlier this month that reported results of the test on 400 blood samples, half of which were from prior COVID-19 patients. The test correctly identified antibodies in previously infected patients 87.5% of the time, a slightly higher rate than ELISA tests performed in hospitals that require hours to perform. The paper is being peer-reviewed.

The test uses hemagglutination, in which the degree of clumping together of red blood cells reveals the concentration of antibodies. Kruse, a pathology resident at the Johns Hopkins University School of Medicine, said the hemagglutination results could let people know if they still have protection months after they received the vaccine or if they need a booster shot. The degree of hemagglutination also correlated with levels of neutralizing antibodies in patients, which protect against viral infection.

Immunocompromised patients, who studies have shown don’t always respond to the COVID-19 vaccine, could test their antibody level and see if the vaccine is working for them, says Yuting Huang, M.D., Ph.D., Kruse’s co-author and a research fellow at Johns Hopkins as well as chief resident of internal medicine at the University of Maryland Medical Center Midtown Campus.

Kruse and Huang developed the test in the lab of Zack Z. Wang, Ph.D., an associate professor at Johns Hopkins in the Division of Hematology. Kruse says the research is an example of the “Hopkins network coming through”: Colleagues in pathology connected Kruse and Huang with researchers from the Johns Hopkins Bloomberg School of Public Health who already had patient samples and test results they were using for their own COVID-19 studies, allowing for collaboration and data-sharing.

“If those collaborating labs didn’t have those samples, we wouldn’t really have known how well it worked,” says Kruse.

Johns Hopkins Technology Ventures is seeking patent protection for the technology, which is available for licensing. The test’s creators are seeking an industry collaborator to manufacture the cards and have applied for funding through TEDCO’s Maryland Innovation Initiative to assist in commercializing its research.

Kruse, Huang and Wang are available for interviews. Watch a demonstration of their test.

WHAT TO EXPECT AND PREPARE FOR AS YOU RETURN TO REGULAR HEALTH CARE APPOINTMENTS

Over the past year-plus of quarantining, many people have avoided leaving their homes as much as possible, not even to see their health care provider for regular checkups and other preventive care. As COVID-19 cases in the U.S. drop, some are wondering how to prepare for non-COVID-related doctor’s visits. Paul O’Rourke, M.D., M.P.H., an assistant professor of medicine at the Johns Hopkins University School of Medicine and the associate program director of the Johns Hopkins Bayview Internal Medicine Residency Program, has some suggestions.

Reflect on your major health questions and concerns before the appointment. “Write them down so you can review them during your visit,” O’Rourke says. “After a long time away, it’s helpful to come prepared and ensure you address the issues important to you.”

Bring a list of your current medications and supplements, as well as documentation of any vaccines (including the COVID-19 vaccine) that you may have received elsewhere. “This enables your physician to update your records and ensure you are current with recommendations,” says O’Rourke.

Prepare for certain aspects of your appointment to be different. “For example, waiting rooms have been rearranged to maintain physical distancing,” O’Rourke says. “Nurses and doctors wear facial coverings now. And some clinics will ask to conduct a COVID-19 screening prior to your appointment.”

“Hesitancy is understandable,” O’Rourke adds. “This has been a very stressful time for everyone. But, it is important for patients to return to medical and preventive care services — and to know that all medical clinics have precautions in place to minimize the risk of acquiring COVID-19.”

O’Rourke cites three primary reasons for patients to return to their doctors: to address any current health concerns; to address any chronic medical conditions, such as diabetes or chronic obstructive pulmonary disease; and to receive preventive health screenings.

For those still concerned about returning to their doctor, O’Rourke encourages them to contact their physician’s office.

“Your health care providers want you to be safe,” he says. “Reach out to them and ask for information about their COVID-19 safety procedures if you need reassurance about coming back.”

O’Rourke is available for interviews to discuss returning to care.

STUDY SUGGESTS SUDDEN HEARING LOSS NOT ASSOCIATED WITH COVID-19 VACCINATION

In a new study, Johns Hopkins Medicine researchers have tried to address recent reports that sudden sensorineural hearing loss — a condition that occurs as a result of damage to the inner ear — has been suspected of being a potential side effect of vaccination against SARS-CoV-2, the virus that causes COVID-19. Their conclusion so far: Vaccination does NOT increase one’s risk for sudden hearing loss.

A research letter detailing the team’s findings appeared May 20 in JAMA Otolaryngology–Head and Neck Surgery.

Researchers at Johns Hopkins and across the country experienced an increase in patients presenting with sensorineural hearing loss after COVID-19 vaccination.

“Sudden hearing loss can occur naturally, so it hasn’t yet been confirmed whether sudden hearing loss occurring after COVID-19 vaccination is coincidental or related to the vaccine,” says study co-author Daniel Sun, M.D., assistant professor of otolaryngology–head and neck surgery at the Johns Hopkins University School of Medicine.

Though current data do not provide clues as to whether the hearing loss is temporary or permanent, doctors have been treating the hearing loss like other cases of idiopathic sudden sensorineural hearing loss, with either steroids by mouth or steroids injected through the ear drum into the middle ear. 

For their study, Sun and colleagues used data related to sudden hearing loss after COVID vaccination from the U.S. Centers for Disease Control and Prevention’s Vaccine Adverse Events Reporting System (VAERS), a national repository of reports tracking medical problems following vaccinations in the country. For the period Dec. 14, 2020, to March 2, 2021, the researchers found 40 reports of sudden hearing loss in 86,553,330 people who received one dose of either the Pfizer or Moderna mRNA vaccines (0.3 cases per 100,000 per year) and 147 reports in 43,276,665 patients who received two doses during the same time span (4.1 cases per 100,000 per year). The investigators narrowed the reports to only those describing hearing loss diagnosed by a clinician within three weeks of receiving the vaccine. Researchers chose data for people experiencing hearing loss in this time frame since vaccines doses are spaced between three and four weeks and hearing loss examined after four weeks may not be correlated to the vaccine.

“Based on the rate of hearing loss reported in VAERS, so far there is no evidence that people receiving a COVID-19 vaccination are at higher risk of developing sudden hearing loss than those who have not been vaccinated,” says Sun.

Individuals should continue to receive COVID-19 vaccinations as recommended by the CDC, Sun says, and clinicians should report any suspected adverse effects, including sudden hearing loss, to the CDC via VAERS. He adds that anyone who experiences sudden hearing loss at any time should immediately seek the care of an otolaryngologist. “The sooner it is treated, the more likely the hearing can be restored,” says Sun.

“Although this preliminary analysis suggests that the COVID-19 vaccine is not associated with sudden hearing loss, more research is needed to address this question,” says study lead author Eric Formeister, M.D., a neurotology fellow at the Johns Hopkins University School of Medicine. “Our study depended on data produced by voluntary submission of reports to a database, so there is a possibility that there was underreporting, meaning that some cases of post-vaccine hearing loss were undocumented.”

To validate the preliminary results of their latest study, the researchers would like to conduct comprehensive investigations that can more accurately define the risk of hearing loss following COVID-19 vaccination. They also plan to look for any specific medical risk factors that may increase the risk of developing sudden hearing loss after COVID vaccination in certain individuals.

Sun and Formeister are available for interviews.

VACCINATION MAY NOT RID COVID-19 RISK FOR THOSE WITH RHEUMATIC, MUSCULOSKELETAL DISEASES

Johns Hopkins Medicine researchers recently reported that while two doses of a vaccine against SARS-CoV-2 — the virus that causes COVID-19 — confers some protection for people who have received solid organ transplants, it isn’t sufficient to enable them to dispense with masks, physical distancing and other safety measures.

Now, the researchers have shown a similar lower-than-normal immune response to the messenger RNA (mRNA) COVID-19 vaccines for patients with rheumatic and musculoskeletal diseases (RMDs), conditions that often call for treatment with medications that suppress the immune system.

The study was detailed in a research letter published May 25 in the Annals of Internal Medicine.

“Our findings suggest that patients with RMDs who are on immunosuppressive therapies have less-than-optimal responses to vaccination, and therefore, are still at risk for SARS-CoV-2 infection,” says study lead author Caoilfhionn Connolly, M.D., a postdoctoral fellow in rheumatology at the Johns Hopkins University School of Medicine.

According to the American College of Rheumatology, RMDs are a diverse group of autoimmune diseases that affect children and adults, and can impact any organ of the body, often the joints. Most RMDs are due to problems of the immune system, which can result in inflammation and gradual deterioration of joints, muscles and bones. Over 46 million people in the United States are living with some type of RMD, including rheumatoid arthritis, systemic lupus erythematosus, scleroderma, vasculitis and Sjögren’s syndrome.

Between Dec. 7, 2020, and March 11, 2021, the Johns Hopkins Medicine researchers recruited patients age 18 and older with RMDs for the immune response study. One month after the participants received their second dose of either the Pfizer-BioNTech or Moderna mRNA COVID-19 vaccine, blood samples were analyzed for neutralizing antibodies against the target of both vaccines, the SARS-CoV-2 spike protein.

Twenty patients did not have detectable antibodies. The majority were women (95%), white (90%), diagnosed with lupus (50%) and receiving multiple immunosuppressive agents (80%) — of which the most common medications were rituximab (55%), a biologic used to treat autoimmune disorders such as rheumatoid arthritis and vasculitis, and mycophenolate (50%), a drug commonly used as a first-line therapy for scleroderma lung disease and lupus nephritis (kidney inflammation). Both immune suppressants work by depleting B-lymphocytes (also known as B-cells), immune cells that produce antibodies in response to foreign invaders such as bacteria and viruses.

“Based on our findings, we urge patients with autoimmune diseases who are taking these particular immunosuppressive agents to continue practicing recommended COVID-19 safety measures, even after vaccination,” says study co-author Brian Boyarsky, M.D., Ph.D., a research fellow at the Johns Hopkins University School of Medicine.

Connolly and Boyarsky say additional research is needed to better understand the immune response to COVID-19 vaccination in patients with RMDs to find potential methods for raising the vaccine effectiveness in this population — including adjusting the dosage and timing of immunosuppressive agents prior to vaccination.

Connolly and Boyarsky 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.