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EILI KLEIN, PH.D.: WE COULD BE LOOKING AT A FAIRLY NORMAL FALL
VIDEO: COVID-19 Story Tip: Eili Klein – We Could Be Looking At A Fairly Normal Fall
Coronavirus vaccines are rolling out across the country, so, what does that mean for the outlook of the pandemic?
Eili Klein, Ph.D., associate professor of emergency medicine at Johns Hopkins University School of Medicine, who has been working on modeling the pandemic, explains what the vaccine means for all of us.
“For the first time, we’re not facing an oncoming train,” says Klein, “but that does not change the epidemiology of what we’re facing in the next few months.” He expects that we will be facing a tough winter and will need to continue physical distancing and wearing masks until many more Americans are vaccinated over the summer months.
BRAIN FOG, FATIGUE, DIZZINESS… POST-COVID POTS IS REAL
For almost one year, COVID-19 has impacted the world and taken the lives of many people. While some survivors have fully recovered from this illness, others are still experiencing lingering effects, such as chronic fatigue, brain fog, dizziness and increased heart rate. These survivors have been called “long-haulers,” and experts say some of the symptoms they are experiencing are thought to be caused by postural orthostatic tachycardia syndrome (POTS), a blood circulation disorder.
Some patients may, at first, believe their symptoms are “all in their head,” but Tae Chung, M.D., assistant professor of physical medicine and rehabilitation and neurology at the Johns Hopkins University School of Medicine and director of the Johns Hopkins POTS Program, says “POTS is very real.”
While experts are still researching the long-term side effects of COVID-19, it is clear to experts that some survivors are experiencing the classic signs of POTS as a result of their COVID-19 diagnosis.
Chung says POTS is related to autonomic nerve dysfunction. He explains that the autonomic nervous system is responsible for involuntary control of many of our body functions, such as sweating, pupil movement, bowel movement and blood flow. Many POTS symptoms are thought to be related to inadequate control of blood flow, causing brain fog and dizziness. Chung suspects that COVID-19 may be associated with chronic inflammation in the autonomic nervous system, causing POTS.
Before POTS can be diagnosed, patients usually have symptoms for six months. Since the pandemic began last March, physicians are just now beginning to see patients with post-COVID POTS.
Michaelene Carlton — who sees Chung in the POTS Program — was diagnosed with COVID-19 in March. Carlton says she started experiencing an increased heart rate when she stood, in addition to dizziness and fatigue, after she had recovered from COVID-19. She was later diagnosed with POTS, a disorder she wasn’t aware existed, prior to her diagnosis.
Chung is available for media interviews on post-COVID POTS. Michaelene Carlton is also available for media interviews to discuss her experience with the illness.
EXPERTS SAY CURRENT PREVENTION MEASURES BEST WAY TO DEAL WITH NEW COVID-19 VIRUS STRAINS
In recent weeks, genetically divergent strains of SARS-CoV-2, the virus behind COVID-19, have been reported to be rapidly spreading in the United Kingdom, South Africa and other nations, fueling fears that a darker chapter may be looming in the story of the current pandemic. Two Johns Hopkins Medicine infectious disease experts say that while the variant viruses and the illnesses they produce should be carefully followed and studied, these events do not warrant either more concern or, more importantly, any changes in established prevention measures and ongoing vaccination programs.
“There is no demonstration yet that these strains are biologically different in ways that would require any change in current recommendations meant to limit the spread of COVID-19,” says Stuart Ray, M.D., professor of medicine at the Johns Hopkins University School of Medicine. “In particular, there is no evidence at this time indicating that immune responses produced by the current vaccines would be evaded by these strains.”
Agreeing with Ray is his colleague, Robert Bollinger, Jr., M.D., M.P.H., the Raj and Kamla Gupta Professor of Infectious Diseases and professor of medicine at Johns Hopkins University School of Medicine.
“All viruses mutate over time — with the influenza virus as the best-known example — and we learn to deal with those changes accordingly,” Bollinger says. “There is no reason to believe that the COVID-19 vaccines currently being administered will not work with the SARS-CoV-2 variants reported in Europe and Africa. And scientists around the world will be examining the genetic makeup of the new strains to ensure that situation doesn’t change.”
Bollinger notes that the SARS-CoV-2 variant first detected in southeast England this past September has now become the most common cause of COVID-19 in the region, responsible for about 60% of all new cases in London. Travelers from the United Kingdom have spread the strain to other countries, including Denmark, the Netherlands and possibly Belgium.
Although the new virus strain — and another genetic variant like it in South Africa — have been reported as more easily transmitted than the original strain, Bollinger says that people should not panic.
“They may be easier to spread, but there is no evidence that they are more dangerous in terms of causing a more severe form of COVID-19,” he explains. “Besides, environmental or behavioral factors might be responsible for the recent surge in cases in England, rather than a genetic change in the virus.”
Ray says that the emergence of SARS-CoV-2 genetic variants underscores the continuing need to follow proven protective measures, such as wearing a mask in public, frequent hand washing and physical distancing.
“As the virus continues to mutate and exploit more of its genetic landscape, there is always the small possibility that it will adapt to antiviral drugs and vaccines, making the current therapies less effective,” says Ray. “Not contracting and spreading the virus — no matter which strains we encounter — is still the best way to beat the pandemic.”
Ray and Bollinger are available for interviews.
RACIAL DIVIDE: MARYLAND SUICIDES DURING THE PANDEMIC HALVED IN WHITES, DOUBLED IN BLACKS
In a study that looked at suicide deaths during 2020’s first wave of the COVID-19 pandemic in Maryland, Johns Hopkins Medicine researchers found that, contrary to general predictions of suicides skyrocketing, suicides in the overall population actually dropped, relative to previous years. However, the researchers also discovered that suicide deaths increased dramatically among Black Marylanders during the same period.
The researchers say that their findings, published Dec. 16, 2020, in JAMA Psychiatry, highlight the importance of timely identification of high-risk groups and vulnerable populations to reduce suicide numbers.
Black Americans have been disproportionately affected by the COVID-19 pandemic, underlining long-standing health and social inequities. “Looking at suicide trends by race emphasizes the economic divide we’re seeing in America and unfortunately, that divide also is a racial one,” says Paul Nestadt, M.D., assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine.
According to Nestadt, the increase in suicides among Black Marylanders — during the period when COVID-19 deaths peaked and the state was locked down — could be reflective of a socioeconomic divide. In comparison, he adds, the unexpected decrease in suicides in white Marylanders could be due to greater capacity for remote work or benefit from economic relief efforts.
“I think we’re all in this COVID-19 storm together, but not everyone is having the same experience,” says Nestadt. “Folks who are in places of economic privilege have been able to continue working more or less remotely, to take time off for themselves, reconnect with family, start a new hobby and so on, but it’s a very different story for people working in service industry jobs.”
In their study, the researchers looked at suicide deaths from Jan. 1 through July 7, 2020. The data were divided into three periods: a pre-COVID-19 period 1 (Jan. 1 to March 4, 2020); a “progressive closure” (lockdown) period 2 (March 5 to May 7, 2020); and a “progressive reopening” period 3 (May 8 to July 7, 2020). Daily suicide mortality was divided by race and compared with the same periods, from 2017 through 2019.
During period 1, daily suicide mortality did not differ from the same period in 2017 through 2019 for either race, and, in period 3, the rates did not differ for Black residents compared with previous years. However, period 2 daily suicide deaths among Blacks increased by 94% and decreased 45% among whites, compared with the same period in 2017 through2019.
“The implications of our findings are more far-reaching than just suicidology,” says Nestadt. “It should help policymakers recognize the importance of things like economic relief and increasing access to equal care, so that there’s an end to such disproportionate deaths.”
Nestadt says further research is needed to characterize these trends. As continuing pandemic restrictions drive public health priorities, he says, policy interventions and targeted resource allocation are needed to mitigate disparities affecting Black Americans.
JOHNS HOPKINS EXPERT DISCUSSES BEST PRACTICES TO COMBAT MASK IRRITATION
Wearing a face mask during the COVID-19 pandemic has played a pivotal role in stopping the spread of the virus. While masks protect us from becoming infected and spreading the virus, they have also caused some unpleasant and annoying consequences for our skin.
Many people have developed facial acne, rosacea and other skin irritation resulting from face coverings, such as masks and shields. Anna Chien, M.D., associate professor of dermatology at Johns Hopkins University School of Medicine, is among the many clinicians who have been dealing with this condition.
Chien says that many factors can contribute to these breakouts, including age; the length of time a mask is worn; the fit of the covering; allergic reactions to the materials or chemicals making up the mask; and the overall condition of one’s skin.
“Age can potentially play a role, since our skin barriers aren’t quite as good as we age,” says Chien. “However, it really has more to do with how long someone wears a mask — especially in work or other activities where it’s needed for long periods — as well as an individuals’ propensity for skin conditions. Some people may just naturally have more sensitive skin and or skin prone to acne.”
As for the clinical signs of skin inflammation caused by masks, Chien says they can include red bumps, pimples, red rashes, irritation or chafing. “You may even experience scaly and itchy skin,” she adds.
To protect your skin from masks, Chien suggests:
- Try to take mask breaks, if possible. Time is a big factor in minimizing skin irritation.
- Make sure your mask fits properly. “It should be comfortable around your nose and ears because those are the areas where we see the most chaffing,” Chien explains.
- Choose a mask that works best with your skin. If work regulations and other requirements permit you to have a choice of masks, Chien says that cotton and polyester blends are best for people with more sensitive skin.
- For mild cases, implement a good, gentle skin care regimen. Mild soaps without any fragrances or antibacterial chemicals are best. Stick to a very bland moisturizer at night.
- Barrier creams, such as petroleum jelly and even baby rash ointments, can help prevent sores and skin irritations. Ask your doctor about topical and oral medications, if over-the-counter treatments aren’t working.
Chien is 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.
