Front-Line Worker Story: Joseph Cofrancesco Jr., M.D., M.P.H. — You Are Not Alone
It seems as though there will never be enough “thank-you’s” for the incredible doctors, nurses, technicians and support staff who are working around the clock to help patients with this dangerous coronavirus disease. It’s their dedication, determination and spirit that enable Johns Hopkins to deliver the promise of medicine.
Joseph Cofrancesco is a professor of medicine at the Johns Hopkins University School of Medicine. He is no stranger to pandemics — he trained in New York City in 1990 during the AIDS crisis. However, the COVID-19 pandemic hit close to home. Cofrancesco’s brother John spent his last weeks of life in the hospital, away from family, before passing away from COVID-19 complications in March. “It is a challenging time. We couldn’t visit him in the hospital, I couldn’t go home to be with family. We couldn’t have a funeral,” says Cofrancesco. As a small way to honor his brother’s memory, Cofrancesco took on extra shifts caring for COVID patients at The Johns Hopkins Hospital. “As a doctor, I took an oath. I want to care for these patients and make sure they know they are not alone.”
Cofrancesco is available to discuss his experience with journalists.
Beware of False Negatives in Diagnostic Testing of COVID-19
One of the most commonly used diagnostic tools, particularly during this pandemic, is the reverse transcriptase polymerase chain reaction test (RT-PCR), which uses a person’s respiratory sample to detect viral particles and determine if the person may have been exposed to a virus. Laboratory professionals across the U.S. and the globe have used RT-PCR to find out if a person has been infected with SARS-CoV-2, the virus that causes COVID-19. These tests have played a critical role in our nation’s response to the pandemic. But, while they are important, researchers at Johns Hopkins have found that the chance of a false negative result — when a virus is not detected in a person who actually is, or recently has been, infected — is greater than 1 in 5 and, at times, far higher. The researchers caution that the predictive value of these tests may not always yield accurate results, and timing of the test seems to matter greatly in the accuracy.
In the report on the findings published May 13 in the journal Annals of Internal Medicine, the researchers found that the probability of a false negative result decreases from 100% on Day 1 of being infected to 67% on Day 4. The false negative rate decreased to 20% on Day 8 (three days after a person begins experiencing symptoms). They also found that on the day a person started experiencing actual symptoms of illness, the average false negative rate was 38%. In addition, the false negative rate began to increase again from 21% on Day 9 to 66% on Day 21.
The study, which analyzed seven previously published studies on RT-PCR performance, adds to evidence that caution should be used in the interpretation of negative test results, particularly for individuals likely to have been exposed or who have symptoms consistent with COVID-19.
Lauren Kucirka, M.D., Ph.D., gynecology and obstetrics resident physician, and Justin Lessler, Ph.D. associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health, are available for comment on false negatives in diagnostic testing for SARS-CoV-2.
Helping Coronavirus Patients Who Lose Their Sense of Smell and Taste
COVID-19 symptoms vary from person to person, but an overwhelming majority of people infected have one thing in common: They have lost some sense of smell and taste.
Patients typically lose their sense of smell and taste for an obvious reason, such as a head injury or nasal blockage. But the smell and taste loss associated with COVID-19 appears to be unique to the novel coronavirus according to Nicholas Rowan, M.D., an assistant professor of otolaryngology–head and neck surgery at the Johns Hopkins University School of Medicine.
“The most unique finding that occurs is that patients may lose their smell and taste in an isolated fashion,” he says. “It happens all of a sudden and in many cases without any other symptoms.” Emerging data shows the novel coronavirus directly infects the area of the smell nerve, he adds, and this may be how the virus gains entry into its human host.
More worrisome to Rowan is that someone experiencing a loss of smell and taste might not recognize they have COVID-19 and continue to expose themselves to others. In the absence of widely available antibody testing, tracking smell and taste loss may represent a way to track the spread of the virus, as well as an infected patient’s immune response.
Preliminary evidence demonstrates that a majority of people with COVID-19 who lose their sense of smell and taste will recover it, but there is concern it might be permanent for some, according to Rowan. Treatment of smell loss for patients with COVID-19 centers on smell training that can be performed with essential oils or other scents.
“It’s like going to rehab after a stroke or an injury,” says Rowan, whose team has written a forthcoming article reviewing all available treatment options for viral-associated smell loss. “You’re learning to use that body part again.”
Rowan is available to discuss the importance of smell and taste loss in the setting of COVID-19, and his treatment of patients trying to regain their sense of taste and smell, including how he can help their recovery through telemedicine.
Pediatricians Urge Measures to Counter Covid-19 Impacts on Health and Well-Being of Children from Low-Income Households
The COVID-19 pandemic has magnified the social, educational and health care disparities already plaguing the nearly 40 million Americans the U.S. Census Bureau estimates are living in poverty. Perhaps the hardest hit members of that population, say three pediatricians at Johns Hopkins Children’s Center and Children’s National Hospital, are children from low-income households who are experiencing major disruptions in already inconsistent routines and less-than-adequate resources critical to learning, nutrition and social development because of restrictions in place to curb the spread of the disease.
In a viewpoint article published in the May 13 issue of JAMA Pediatrics, the physicians provide examples of how efforts to keep COVID-19 in check have disproportionally impacted the nearly 1 in 5 U.S. children whose family incomes are below the poverty level.
“For example, many school districts are engaging in distance learning during the pandemic, but there is wide variability in the ability to access quality educational instruction, digital technology and internet service, especially by rural and urban students,” says Megan Tschudy, M.D., M.P.H., assistant medical director at the Harriet Lane Clinic of Johns Hopkins Children’s Center and assistant professor of pediatrics at the Johns Hopkins University School of Medicine. “In some urban areas, as many as one-third of students are not participating in online classes because of challenges accessing the internet.”
The authors cite other difficulties that COVID-19 policies and regulations have placed on children from low-income households, including missing months of school by a student population commonly burdened by chronic absenteeism, the inability to get nutritious meals previously provided before and during school hours, and removal of key resources available at schools such as “consistent and caring adults who can help build resiliency and offer holistic support.”
To counter the increased disparities brought about by the pandemic and help prevent children from low-income households “experiencing consequences for a lifetime,” the authors recommend that future COVID-19 legislation target child health and well-being. They say that this effort should include expanding services and increasing funding for health and nutrition assistance programs, improving child tax credits, and expanding access to high-speed internet and versatile electronic devices so that all children can participate in distance learning.
Along with Tschudy, who is available for interviews, the other authors of the viewpoint article are Danielle Dooley, M.D., medical director for community affairs and population health, and Asad Bandealy, M.D., pediatrician, both of whom are at Children’s National Hospital in Washington, D.C.
It May Take Up to a Year to Get Through Backlogged Elective Surgeries Due to COVID-19
A new study by Johns Hopkins researchers found that it may take between seven and 16 months for surgeons to complete the backlog of elective orthopaedic surgeries that have been suspended during the COVID-19 pandemic. This accounts for more than a million surgeries in the U.S. for spinal fusion and knee and hip replacements.
The study was published online May 12 in The Journal of Bone and Joint Surgery.
Lead author Amit Jain, M.D., chief of minimally invasive and outpatient spine surgery and associate professor of orthopaedic surgery and neurosurgery at the Johns Hopkins University School of Medicine, says that in fields such as orthopaedic surgery, where procedures are frequently performed in an inpatient setting, the ramp-up may be slower than surgeries typically done in outpatient facilities. “We will keep adding to the backlog as long as we are not operating at 100% capacity,” states Jain.
Jain and his colleagues used the Agency for Healthcare Research and Quality National Inpatient Sample, a national database that contains hospital inpatient data, to model the number of current and forecasted spinal fusion and hip and knee replacement surgeries in the United States. The researchers found that, in an optimistic scenario where most elective surgeries are back to full capacity in June, it would take approximately seven months to get through the backlog. Delays to the ramp-up to full capacity could extend the backlog to 16 months.
To help ease the backlog, Jain proposes several strategies to increase surgical throughput, including more use of telemedicine. At Johns Hopkins, telemedicine use has skyrocketed. He also suggests making more timeslots available in operating rooms for orthopaedic surgeries, increasing care coordination resources and shifting care to ambulatory surgery centers as much as possible.
Jain is available to discuss further the implications of the study’s findings.
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.