Front-Line Worker Story: Sandra Zaeh, M.D. — COVID-19 from Diagnosis to Recovery
Media Contact: Rachel Butch
It seems like 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 with this dangerous disease. It is their dedication, determination and spirit that allow Johns Hopkins to deliver the promise of medicine.
Sandy Zaeh is a pulmonary critical care fellow at The Johns Hopkins Hospital. Zaeh’s training experience at Johns Hopkins is far from usual. She’s now taken on the intense responsibility of caring for patients with some of the worst cases of COVID-19. However, these trying times have offered a unique opportunity: to follow her patients from the intensive care unit (ICU) through their recovery. She’s a member of the post-acute COVID-19 team that helps recovering patients navigate their return to everyday life. “It is unbelievable to see a patient who has been fighting for their life for weeks to recover enough to go home,” says Zaeh.
Sandy Zaeh is available for interviews with the press.
Johns Hopkins Team Develops New Method to Make Kidney Dialysis Fluid for Patients with COVID-19
Media Contact: Michael E. Newman
The ongoing COVID-19 pandemic has severely impacted the manufacturing and supply chains for many products. But while shortages of toilet paper, disinfectant cleaners and hand sanitizer get most of the news coverage, the diminishing reserve of one item — kidney dialysis fluid, also known as dialysate — presents a grave threat to the lives of people with acute kidney injury (AKI), including the approximately 3% to 9% of COVID-19 patients who develop the disorder.
Without the special type of 24-hour, slowly administered dialysis — called continuous veno-venous hemodialysis, or CVVHD — that is given to AKI patients in an intensive care unit, damaged kidneys cannot remove wastes and excess fluids from the blood as they normally do. Unfortunately, the COVID-19 pandemic has severely tapped dialysate supplies across the nation.
When two New York-based hospitals recently contacted Derek Fine, M.D., clinical director of nephrology at the Johns Hopkins University School of Medicine, to seek spare dialysate to help meet their need for some 3,000 liters per day (for all of their AKI patients in ICUs, both with and without COVID-19), he and Chirag Parikh, M.D., Ph.D., M.B.B.S., director of the medical school’s Division of Nephrology, came up with a better idea to remedy the problem.
Their solution was to replace the dwindling stocks of pre-mixed, commercially produced dialysate required for short-term ICU kidney dialysis machines with a suitable substitute manufactured by conventional hemodialysis devices and designed for long-term treatment.
The latter creates its own dialysate in real time from ultrapure water and concentrated chemical solutions.
Fine, Parikh and colleagues from their division studied the workings of a conventional dialysis machine, learned how it manufactures dialysate and then adjusted the system to override alarms, which if triggered would automatically shut down dialysate production. However, one major obstacle remained: how to get the newly minted dialysate into bags.
No problem, thanks to students from the Johns Hopkins University Department of Biomedical Engineering. In just 12 hours, they designed a connector and used a 3D printer to render the plastic piece.
“When we tried it out, we were successfully able to capture the dialysate, and that was the eureka moment,” Parikh says.
The U.S. Food and Drug Administration has already provided guidelines for the method, calling for all dialysate produced to be tested intermittently for bacteria and used within 12 hours from its origin. The two New York hospitals that spurred the birth of the new technique are reporting that it has enabled them to maintain sufficient supplies of dialysate for CVVHD.
Parikh and Fine, who are available for interviews, have posted instructions on converting a hemodialysis machine to produce dialysate, and the files for printing the connector, in a Google document or via Twitter: @KidneydrChirag.
What Will It Take to Get Critically Ill COVID-19 Patients Ready for Discharge?
Media Contact: Waun’Shae Blount
Recovery for patients who are COVID-19 positive and who are admitted to the hospital frequently includes a stay in the intensive care unit, often for long periods of time, and long ICU stays can sometimes lead to complications. According to Johns Hopkins experts, doctors need to tend to the patient’s current medical needs while considering the long-term health implications from a long ICU hospitalization, which may include significant rehab to help them recovery.
Johns Hopkins Physical Medicine and Rehabilitation teams have put into practice years of experience and training, and implemented an interdisciplinary approach to providing rehab care to patients who are COVID-19 positive that includes multiple sessions of therapy per day while a patient is still in the hospital, oftentimes in the intensive care unit. This is a unique approach not currently used by many hospitals in the nation, but Johns Hopkins experts say physiatrists around the globe should implement it in their health systems.
The unique approach includes physiatrists, physical therapists, occupational therapists, speech therapists and rehab psychologists assisting patients who are COVID-19 positive and who are medically ready to get up and move much sooner, while preparing patients for a smooth transition to home or outpatient rehab. Survivors of COVID-19 are often deconditioned and debilitated, and have a hoarse voice and some trouble swallowing. The interdisciplinary approach is critical to getting impaired patients prepared to successfully re-integrate into their home and the community.
April Pruski, M.D., assistant professor of physical medicine and rehabilitation, is available for comment on the early rehab measures the teams must take to mobilize patients who are COVID-19 positive while still in the hospital.
Pediatric Multisystem Inflammatory Syndrome and COVID-19
Media Contact: Waun’Shae Blount
Pediatric multisystem inflammatory syndrome (PMIS) is a very rare disease potentially linked to new coronavirus infection (which is responsible for COVID-19) in children and teens. The condition is marked by symptoms similar to those of Kawasaki disease and toxic shock syndrome, including body inflammation, rash, high fever, upset stomach and cardiac dysfunction, but there are some differences. For example, Kawasaki disease occurs commonly in children younger than 5 years of age and in children of Asian ancestry, but PMIS occurs in children of any age and so far has not been reported from Asian countries such as Japan, China and Korea.
Though dozens of cases have been reported in the U.S. and worldwide, researchers do not have strong evidence regarding what is causing the sudden surge in cases, but they have found that children who develop symptoms also test positive for COVID-19 antibodies — meaning they likely recently had the illness. More research is needed to better understand the syndrome and its connection to the new coronavirus infection.
While scientific investigations are underway around the world, parents are encouraged to monitor their children for symptoms including a rash, prolonged fever, tiredness and being less active than usual. Important to note, children may not have any specific symptoms, making this condition sometimes challenging for parents to spot. Treatment options are still being investigated, but may include treatments for Kawasaki disease such as intravenous immunoglobulin (IVIG), steroids and other anti-inflammatory drugs.
Expert Kwang Sik Kim, M.D., director of the Eudowood Division of Pediatric Infectious Diseases, is available for comment on pediatric multisystem inflammatory syndrome.
Does COVID-19 Affect the Brain?
Media Contact: Rachel Butch
As COVID-19 spreads around the globe, the impact on the human body may be far wider than only the damage it causes in the lungs. One area of particular concern among researchers is the virus’s potential impact on the brain.
Among the first symptoms of COVID-19 is the loss of smell and taste, and there are reports of people in recovery struggling with cognitive impairment or stroke. According to researchers, these symptoms could be caused by neurons degenerating or damage to blood vessels that feed the brain.
“We need to get an understanding of how brain cells are affected by COVID-19, which cells are affected and how we can slow the damage,” says Valina Dawson, Ph.D., director of the neuroregeneration and stem cell programs at Johns Hopkins’ Institute for Cell Engineering.
Dawson plans to study cells in the nervous system that may be susceptible to damage from the virus. The Johns Hopkins team will start with the basic question of which cell types are affected by the coronavirus, looking at neurons as well as supportive cells in the brain called glia and microglia, and the brain’s blood cells. Then, the team aims to use human stem cells to create “minibrains” in the laboratory that replicate how COVID-19 infections may affect the human brain.
“If we know how the disease progresses and in which brain cells, we can help inform future treatments,” says Dawson.
A second facet of the study will look at the long-term outlook for COVID-19 patients. Dawson aims to collaborate with pathology experts to examine the proteins in the brains of people who succumbed to COVID-19 — proteins such as tau and alpha synuclein —that are susceptible to misfolding. This trait causes them to aggregate in the brain, leading to damage to the surrounding tissues. These are the same proteins Dawson believes are responsible for the progression of neurodegenerative disease including Parkinson’s disease, Alzheimer’s and amytropic lateral sclerosis (ALS).
Dawson suspects that the stress of a coronavirus infection on a person’s brain could drive these proteins to accumulate more quickly.
“We want to know if we could potentially face a tsunami of increased neurodegenerative disease onset among COVID-19 survivors,” says Dawson.
Dawson is available to discuss her research.
I’ve Recovered. When Can I Come Out of Isolation?
As more and more people are recovering from COVID-19, they may be unsure when it’s all right to resume trips to the grocery store, pharmacy or other places for essentials without being a risk to others. Johns Hopkins infectious disease specialist Sara Keller, M.D., M.P.H., M.S.H.P., and her colleagues recommend following the Centers for Disease Control and Prevention’s guidance, which says that a person should remain in isolation for the following conditions, whichever is later:
• At least 14 days after exposure
• At least 10 days after the start of symptoms
• At least three days after the last fever if no fever-reducing medications were taken
• At least three days after other symptoms resolved, such as cough or shortness of breath
• At least three full days after symptoms such as fever, shortness of breath or coughing subside
For anyone with prolonged illness; patients with certain conditions, such as specific kinds of cancer; and people who are immunosuppressed, such as organ transplant recipients, Johns Hopkins physicians recommend retesting to ensure they no longer have the virus before coming out of isolation. They recommend similar retesting for residents of nursing homes or people who are homeless.
Experts recommend that those who have recovered still practice social distancing, wash their hands frequently, and follow their state or local quarantine guidelines.
Keller is available to journalists to discuss how to appropriately emerge from isolation.
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.