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UrduNEWS STORIES IN THIS ISSUE:
– Case Study Suggests Young People May Be Susceptible to Chronic Fatigue Following COVID-19
– Johns Hopkins Patient Breathes Easier After Nearly Yearlong Battle Following COVID-19
– COVID-19 Vaccine Approved for Kids 12 and Up – What to Expect
CASE STUDY SUGGESTS YOUNG PEOPLE MAY BE SUSCEPTIBLE TO CHRONIC FATIGUE FOLLOWING COVID-19
With more adolescents and young adults being treated for COVID-19, clinicians are concerned that these people also will start showing post-COVID — or “long haul” — symptoms from their bouts with the virus. A recent Johns Hopkins Medicine review of three case studies provides some of the first evidence that one serious post-COVID problem may be myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), the complex, multisystem disorder previously known as chronic fatigue syndrome.
The findings were published April 29 in the journal Frontiers in Medicine.
“In the three patients studied — all of whom had confirmed or highly probable COVID-19 infections early in the pandemic — we observed ME/CFS-like symptoms within the first two weeks of illness,” says Peter Rowe, M.D., director of the Chronic Fatigue Clinic at Johns Hopkins Children’s Center and professor of pediatrics at the Johns Hopkins University School of Medicine. “At six months following their illness, all three still met the criteria for being diagnosed with ME/CFS.”
In a recent report, the U.S. Centers for Disease Control and Prevention (CDC) noted that U.S. hospitals are seeing more adolescents and young adults admitted with COVID-19 as more contagious variants of SARS-CoV-2 — the virus that causes the disease — spread. The agency believes that the youthful case surge may be the result of those ages 10 to 24 being among the last prioritized to get the coronavirus vaccines, and the fact that many who are eligible have yet to receive their shots. Also, the CDC says, this group is more likely to be involved in high-risk behaviors such as playing close-contact sports and going out to bars.
The three patients evaluated in the recent study were a 19-year-old man and two women, ages 22 and 30, whose COVID-19 symptoms began between April and June 2020, and who were referred to the Chronic Fatigue Clinic between August and October of the same year. Symptoms of orthostatic intolerance — a group of clinical conditions that includes fatigue, lightheadedness and difficulty concentrating, and are linked with greater than 90% of the people with ME/CFS — were prominent in all three from the outset of their COVID-19 illness.
A six-month post-COVID symptom onset examination, including evaluations of movement, neurological function and continued orthostatic intolerance, was conducted on each of the patients to determine if ME/CFS could be diagnosed. All three easily met the criteria.
Interestingly, Rowe says, all three patients had relatively mild COVID-19 respiratory symptoms and none required hospitalization, yet it appears to have translated into the more serious secondary problem of ME/CFS for them all.
“This finding is consistent with previous studies in older patients with COVID-19 who showed persistent fatigue months after infection, regardless of the severity of the initial infection,” he explains. “This raises the question of how many ME/CFS cases before the COVID-19 pandemic might have been due to mild, subclinical or asymptomatic viral infections [such as Epstein-Barr virus or human herpesvirus 6], including cases in adolescents, young adults and older people.”
Rowe and his colleagues feel that further research is needed to define the biological mechanism by which ME/CFS arises from COVID-19, and then use that insight to develop treatment strategies that can return patients with post-COVID ME/CFS back to their previous quality of life.
Rowe is available for interviews.
JOHNS HOPKINS PATIENT BREATHES EASIER AFTER NEARLY YEARLONG BATTLE FOLLOWING COVID-19
Getting COVID-19 in March 2020 was challenging enough for then 55-year-old Mt. Airy resident Tricia Gibbons. However, what she didn’t realize was that her ordeal would end up lasting nearly a year after her initial diagnosis.
As much of the U.S. was going on lockdown, Tricia developed a fever and achiness. A week later, she tested positive for COVID-19. “I thought I could easily kick this because I don’t usually get sick,” Gibbons says. However, over the next few days, her condition worsened: Her fever stayed continuously at 104 degrees, she could hardly move, and all she could do was sleep.
She was admitted to the intensive care unit at a nearby hospital on April 5. Her condition continued to deteriorate to the point that Tricia was placed on a ventilator, where she remained for 12 days. She was soon discharged to a rehabilitation facility for physical therapy to learn to walk and stand again. Though therapy helped her relearn those activities, she could barely talk and breathing remained difficult.
During an appointment with an otolaryngologist, she was directed to go immediately to the emergency room at Johns Hopkins Bayview Medical Center, where she met Simon Best, M.D., associate professor of otolaryngology–head and neck surgery at the Johns Hopkins University School of Medicine. She was diagnosed with severe tracheal stenosis, a narrowing of her trachea or windpipe, and underwent an emergency procedure to place a tracheotomy to open her airway through her neck.
“Mrs. Gibbons was in airway distress,” Best says. “After some patients are intubated for prolonged periods, scar tissue forms and the airway gets narrower and narrower. She was breathing through an airway that was the size of a straw.”
When a patient is placed on a ventilator, a breathing tube is inserted through the vocal cords into the trachea, or airway. The longer that breathing tube is in place, the higher the risk of injury to a patient’s vocal cords and trachea, including scarring and narrowing. For many patients with COVID-19 pneumonia, ventilator support is needed for days or even weeks. Best alone has seen more than 20 patients diagnosed with COVID-19 with a similar type of vocal cord injury as Tricia, and data from The Johns Hopkins Hospital indicates that these issues may affect up to 20% of patients with long-term intubation from COVID-19.
After three different endoscopic procedures in an attempt to widen Tricia’s airway weren’t successful, Best decided that a tracheal resection was needed, a more complicated surgery to remove damaged and diseased sections of Tricia’s windpipe. Tricia calls it a Hail Mary shot to give her a chance to breathe without the tracheotomy.
For the procedure, Best teamed up with Richard Battafarano, M.D., Ph.D., director of the Division of General Thoracic Surgery at Johns Hopkins Medicine.
The surgery took place in December 2020 at The Johns Hopkins Hospital. During the seven-hour-long procedure, the team removed about 4 centimeters of Tricia’s trachea, more than usual for a woman undergoing the procedure, all due to the severity of the damage from her long-term intubation. The surgery was a success, and one month after surgery, Tricia’s tracheotomy was removed.
“I couldn’t smell. I couldn’t breathe through my mouth and nose. I couldn’t speak at all except for holding the trach,” Tricia says. Now that the tracheotomy tube is removed, she can breathe normally. In addition, even though Tricia still has some raspiness, she now has a voice.
Tricia calculated that she has spent a total of 65 days in the hospital over the past year, and she estimates more than 125 medical professionals have cared for her during that same timeframe.
“It really took a village,” she says. “I am so grateful to be where I am and to have my life back. I feel like a cat with nine lives.”
Tricia and otolaryngologist Simon Best are available for media interviews to discuss Tricia’s experience as well as vocal cord and airway injuries following ventilator support due to COVID-19.
COVID-19 VACCINE APPROVED FOR KIDS 12 AND UP — WHAT TO EXPECT
Adolescents 12 years old and up can now get a COVID-19 vaccine.
On May 10, 2021, the Food and Drug Administration authorized the emergency use of Pfizer’s COVID-19 vaccine for children ages 12 to 15 years old. The Centers for Disease Control and Prevention subsequently recommended the vaccine for youth in that age group.
Johns Hopkins University School of Medicine and School of Public Health experts strongly recommend everyone 12 years old and older get a COVID vaccine. They agree that the emergency use authorization is an important step to protect the community from COVID-19, including another layer of protection in advance of kids returning to in-person school in the fall.
Results of the recent preliminary Pfizer study of 2,260 volunteers ages 12 to 15 found no cases of COVID-19 among fully vaccinated kids in that age group. Pfizer reported that adolescents had side effects similar to young adults, including pain, fever, chills and fatigue, particularly after the second dose.
Pfizer’s COVID-19 vaccine may also be authorized for children ages 2 to 11 years old as early as fall 2021. The vaccine by Moderna is authorized for people 18 and older, and children younger than 18 years old are currently enrolled in their trials. Johnson & Johnson’s vaccine is authorized for those 18 years and up, and the company had expanded its clinical trial to children as young as 12 years old.
For children who aren’t able to get a vaccine yet, Johns Hopkins experts say the best way parents can reduce the chance of their child catching COVID-19 is by continuing to practice prevention measures, such as wearing face masks and maintaining safe physical distance from others, as well as practicing appropriate hand hygiene.
Johns Hopkins experts are available for media interviews on the COVID-19 vaccine and children:
- Kate Connor, M.D., M.S.P.H., pediatrician at the Children’s Center and assistant professor of pediatrics at the Johns Hopkins University School of Medicine
- Aaron Milstone, M.D. M.H.S, infectious diseases specialist at Johns Hopkins Children’s Center and professor of pediatrics at the Johns Hopkins University School of Medicine
- Kawsar Talaat, M.D., assistant professor at the Johns Hopkins Bloomberg School of Public Health, the Johns Hopkins site principal investigator in the Pfizer/BioNTech COVID-19 vaccine trial for children 6 months to 11 years and the Phase 3 trial of adults 18 and over, and a specialist in infectious diseases with a joint appointment in the Johns Hopkins University School of Medicine
View an article with additional tips about what parents need to know about the COVID-19 vaccine.
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.
