Front-line Worker Story – Ben Bigelow – The Go Team
It seems 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 the dangerous coronavirus disease. Their dedication, determination and spirit enable Johns Hopkins to deliver the promise of medicine.
Ben Bigelow has spent the past few months organizing efforts at The Johns Hopkins Hospital to address and prevent COVID-19 outbreaks in community living facilities. This initiative was formed when Johns Hopkins leadership realized it needed to be proactive to prevent outbreaks like those seen in care facilities across the country.
“Our goal has been to partner with skilled nursing and assisted living facilities, as well as homeless shelters and in-patient treatment programs, to offer testing and infection prevention guidance,” says Bigelow. “I’m proud to be part of an initiative that has allowed us to serve at-risk populations in our community.”
Bigelow is available for interviews. Email JHMedia@jhmi.edu.
New Research Confirms Higher Rates of New Coronavirus in Latinx Populations
In a new analysis of SARS-CoV-2, the virus that causes COVID-19, test results for nearly 38,000 people has found a positivity rate among Latinx populations about three times higher than for any other racial and ethnic group. The findings, published June 18 in the Journal of the American Medical Association (JAMA), adds to evidence of much higher COVID-19 infection rates among U.S. minorities, particularly in the Latinx community. Researchers from the Johns Hopkins Center for Data Science in Emergency Medicine, and the Johns Hopkins University School of Medicine’s Department of Emergency Medicine and Division of Infectious Diseases collaborated on the study.
Out of 37,727 adults and children tested between March 11 and May 25 across five Johns Hopkins Health System hospitals, including emergency departments, and 30 outpatient clinics in the Baltimore-Washington area, 6,162 tests came back positive. Of those tests, the positivity rate for Latinx was 42.6%, significantly higher than those who identified as Black (17.6%), Other (17.2%) or white (8.8%).
Among those who tested positive, 2,212 were admitted to a Johns Hopkins Health System hospital. The study data show that Latinx patients were less likely to be admitted to the hospital (29.1%), compared with Black (41.7%) and white (40.1%) patients.
Researchers Diego Martinez, Ph.D., assistant professor of emergency medicine at the Johns Hopkins University School of Medicine, and Kathleen R. Page, M.D., associate professor of medicine at JHUSOM, and a study member, hypothesize that crowded living conditions, lack of health insurance, fear of deportation and need to work in conditions more likely to expose them to infection all contributed to the higher rate of positive tests.
Martinez and Page are available for media interviews.
Steroid Drug Hailed as Effective COVID-19 Treatment but Questions Linger About Its Use for Black Patients
Recent news stories have widely reported on clinical trial results announcing that a steroid drug called dexamethasone reduced deaths among patients hospitalized for COVID-19. However, a scant amount of data from the trials has been released to the public, prompting scientists to call for more information, insight into trial participant demographics and caution before proclaiming victory.
The call is particularly important, says Johns Hopkins pharmacologist Namandje Bumpus, Ph.D., because dexamethasone, commonly used as an anti-inflammatory drug to treat asthma, allergies and many other conditions, has been shown to work differently for people who are Black than people of other ethnicities.
“It’s possible that dexamethasone could be an option for treating Black people with severe COVID-19, but we need to know that a significant number of Black people have been included in the clinical trials to make sure the drug is safe and works the way it should,” says Bumpus, who was recently named director of the Department of Pharmacology and Molecular Sciences at the Johns Hopkins University School of Medicine.
Bumpus is an expert on how genetics dictates the way drugs are processed in the body. Before she became Johns Hopkins Medicine’s first African American woman department director, she discovered that a common HIV drug may be less effective for people who are Black people who have higher levels of a certain enzyme that processes the drug than among people of other ethnicities.
Outstanding questions about the dexamethasone clinical trials include: How many people who are Black were included in the study? Did it have enough statistical power to detect differences among ethnic populations? Bumpus also notes that dosing differences among research participants could affect the results.
Black people have been reported to show differences in levels of insulin and suppression of immune system T-cells in response to dexamethasone, as compared with people who are white. It has also been reported that pregnant Black women who receive dexamethasone before giving birth have an increased risk of delivering infants with respiratory distress syndrome compared with Black women who receive a similar drug. In contrast, this difference was not seen among women who are white.
“We have a lot of data over decades to suggest that every drug is not a one-size-fits-all solution,” says Bumpus, who also notes that Black people have historically been underrepresented in clinical trials.
She notes that more information is needed to understand the drug’s effects and potential complications in various populations and how clinicians can improve their monitoring systems for such effects.
The Importance of Staying Cool While Wearing a Mask Outside in the Summer Heat
The rising temperatures of summer also mean a rising potential for heat-related illnesses. As the coronavirus pandemic continues, this summer will feature a new heat-related risk factor: face coverings.
“When the heat comes back, we need to be extra cognizant that masks, while important to wear for mitigating the spread of coronavirus, could make things worse for some people,” says Matthew Levy, D.O., M.Sc., an associate professor of emergency medicine at the Johns Hopkins University School of Medicine. “They may result in added stress on the body.”
Health officials encourage everyone to wear a mask outside when around others, and Levy encourages people to be strategic and calculated when going outside, particularly if they have a respiratory condition or underlying health problems that put them at increased risk for COVID-19, such as hypertension, cardiovascular disease or diabetes. Levy also cautions that people should pay attention to signs of heat illness such as dizziness, lightheadedness and dehydration, particularly while wearing face coverings.
Health officials encourage everyone to wear a mask outside around others, and Levy encourages people to be strategic and calculated when going outside with a mask. This, is particularly important for people with a respiratory condition or underlying health problems that put them at increased risk for heat-related illness, such as children under age 4, and those who are overweight or with chronic medical conditions such as hypertension, cardiovascular disease or diabetes. Levy also cautions that people should pay attention to signs of heat illness such as confusion, dizziness or lightheadedness, high body temperature, fainting, loss of consciousness or muscle cramps, particularly while wearing face coverings.
“The same precautions we would ask people who are at risk for heat illness to take, we would recommend here, too,” he says, including going out early in the morning or later at night when it is cooler and limiting time outside in general. It is also important to make sure your home cooling system is working properly, he adds.
Studies show that wearing protective masks can affect the amount of physiological stress on the body and raise the microclimate around the face, Levy says. If it becomes harder to breathe or you feel lightheaded or dizzy under your mask, it’s time to get out of the heat, he says. Levy also stresses the importance of adequate hydration.
How someone will respond to heat stress while wearing a mask depends on a combination of the intensity of the heat, duration of exposure and any underlying medical condition. Regardless of the type of mask, don’t try to make your face feel cooler by dousing the mask in water, Levy says. Getting face coverings wet can compromise their filtration capabilities.
Levy is available for interviews about wearing masks in the heat.
Gatherings and Travel Safety as States Lift Coronavirus Restrictions
As states reopen businesses and venues where crowds are likely to gather, there are many ways to ensure safe travel and engagement. One approach is to test people with and without symptoms of COVID-19. A rapid antigen test can detect the coronavirus in minutes, and those without it can be allowed to enter a restaurant, attend a church service or go on a cruise ship, says William Greenough III, M.D., professor emeritus of medicine at the Johns Hopkins University School of Medicine and associate medical director and clinical chief of the ventilator rehabilitation unit at Johns Hopkins Bayview Medical Center.
In addition to trained medical professionals continuing to test, rapid community testing can allow people infected to learn quickly of their condition and quarantine appropriately.
Another aspect of safe traveling is the use of contact tracing — identifying and contacting those who potentially came in contact with an infected person, and advising them on the next steps. Contact tracing can decrease spread of the virus if the contacts can quarantine for the recommended two to three weeks.
When it comes to transportation, Greenough recommends selecting an airline, train or bus that tests passengers before boarding, seats passengers at least 6 feet apart and adheres to Centers for Disease Control and Prevention (CDC) recommendations regarding vehicle cleaning. Although traveling by car with coronavirus-negative passengers is safer, Greenough notes that all passengers must be mindful of the potential for exposure to the virus when stopping at gas stations, rest stops and other places where crowds may gather.
Camping is safe, Greenough adds, as long as you avoid using facilities and equipment frequently used by others, maintain social distance and prioritize outdoor activities. For out-of-state travel, know the status of the pandemic at your destination, and observe all the precautions the CDC suggests: wash your hands frequently; avoid touching your eyes, nose and mouth; wear a mask; maintain a 6-foot distance from others, and buy food and other items via drive-thru and curbside pickup.
Greenough is available for interviews about traveling safely during the coronavirus pandemic.
Study Ties Racial Disparity’s Impacts on 1918 Pandemic to Similar Effects of COVID-19
The outbreak of influenza that swept the globe in 1918 infected an estimated 500 million people — about one-third of the world’s population at the time — and killed between 20 million and 50 million people, including some 657,000 Americans. However, it has come to be known as “the forgotten pandemic” because the true impact of this medical catastrophe was overshadowed by the devastation of World War I, downplayed by the news media and burdened by poor record keeping.
Even more blurry, say the three members of a Johns Hopkins Medicine history and health equity research team, is the accounting of racial disparities and their effect on Black Americans during the 1918 pandemic. As described in a paper published earlier this month in the Annals of Internal Medicine, the researchers looked at primary sources from a century ago that addressed race as a health factor to gain insight and perspective into the “critical structural inequities and health care gaps” that are still problems for communities of color trying to persevere during the COVID-19 pandemic.
For example, the researchers note that “the few studies examining racial differences in the 1918 pandemic found that the Black population had lower influenza incidence and morbidity but higher case fatality.” The studies, they report, suggested that housing segregation, overcrowded and unsanitary living environments, and poor access to health care exposed Black Americans disproportionately to the flu during the first of three disease waves and, therefore, may have conferred protection against the second and third outbreaks. However, the researchers add, the same factors — along with higher risk for pulmonary disease, malnutrition, and social and economic disparities — made it more likely for Black Americans than white Americans to die from the flu.
The researchers also report that in Baltimore in 1918, “influenza overwhelmed medical resources straining under the burden of urban density, unequal living conditions and a high concentration of military training camps.” The records show, say the researchers, that by the time the city health commissioner admitted the seriousness of the outbreak and imposed restrictions, it was too late to curb the spread of the disease, especially among Black residents.
The researchers say there are important parallels between the 1918 influenza and the current COVID-19 pandemic, and that studying them allows us to “ground our current and future strategies in this historical context, deliver a more equitable pandemic strategy and reduce disparities in marginalized communities.” Based on their comparisons of today’s events with those in 1918, the researchers propose several areas for intervention and mobilization through the various phases of pandemic response.
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.