JOHNS HOPKINS MEDICINE JOINS TOP U.S. HOSPITALS TO ENCOURAGE EVERYONE TO #MASKUP
Growing numbers of COVID-19 cases and deaths are troubling; face masks can slow the trend
Johns Hopkins Medicine, together with 100 of the nation’s other top health care systems, representing thousands of hospitals in communities across the U.S., have come together with an urgent plea for all Americans: mask up, because wearing a face mask is one of the best ways to slow the surging COVID-19 pandemic.
With cases of COVID-19 rising across the nation, it’s more vital than ever for us to join this public health campaign to spread the word about the importance of mask-wearing, among other public health measures such as physical distancing and proper hand-washing.
More than 11.5 million Americans have tested positive for the virus, leading to nearly 250,000 deaths. The next several months will be critical. Though there has been positive news about vaccine development, it’s still unclear when those vaccines will be ready for widespread use. In the meantime, everyone must remain vigilant, take precautions and follow public health recommendations.
By working collaboratively with other health systems, we hope to curb the spread of the virus that causes COVID-19 and get through this together.
The following experts are available for interviews to discuss the importance of wearing a mask and other public health measures that can help stop the spread of COVID-19.
Aaron M. Milstone, M.D., M.H.S., professor of pediatrics at the Johns Hopkins University School of Medicine
Clare Rock, M.B.B.CH., associate professor of medicine at the Johns Hopkins University School of Medicine
Lisa Maragakis, M.D., M.P.H., senior director of infection prevention at The Johns Hopkins Health System
Gabor Kelen, M.D., director of the Department of Emergency Medicine and professor of emergency medicine at the Johns Hopkins University School of Medicine
SCIENTISTS USE ULTRAVIOLET LIGHT TO DISINFECT CT SCANNERS
The COVID-19 pandemic has sparked heightened awareness of cleaning and disinfecting procedures in many industries. Health care facilities have long been familiar with protocols for disinfecting tools and equipment, and now, scientists are studying methods to improve these procedures, making them safer and more efficient for patients and health care workers.
At Johns Hopkins, biomedical engineer Jeff Siewerdsen and radiologist Mahadevappa Mahesh are investigating the use of UV light to disinfect the inner bore of CT scanning machines, a cramped space that is exposed to exhaled particles from patients and is difficult to reach by manually wiping it down.
The UV light being studied is not the typical beam of sunshine that falls to the earth. Those rays are mostly UVA rays, which tend to cause skin cancer and other problems. Siewerdsen and Mahesh are studying UVC rays, which can eliminate a high proportion of SARS-CoV-2 virus from hard surfaces.
They attached a UVC lamp to the bed inside the bore of a CT scanner and found that the UV light wiped out 99.9999% of SARS-CoV-2 virus particles in three to five minutes. A summary of the results was published Nov. 18, along with a video abstract, in the Journal of Applied Clinical Medical Physics.
The lamp used in the study cost $105; however, they did not study the longevity of the lamp. The researchers also note that there may be crevices in the CT scanner that are not reachable with the UV light.
If the UVC procedure for CT scanners proves useful, the process could be used in addition to the manual wipe down of CT scanners, improve the safety of personnel and patients, and applicable to many health care facilities around the globe.
Note: Exposure to UVC light could harm health. UVC lamps should not be used without proper training and safety precautions. Read more information from the FDA.
DOES PROLONGED COVID-19 DETECTION IDENTIFY PEOPLE WHO ARE INFECTIOUS LONG TERM?
Repeated testing for SARS-CoV-2, the virus that causes COVID-19, has become common practice during the ongoing pandemic, especially when there is a strong suspicion that a person is infected with, or has been exposed to, the pathogen. Molecular diagnostics are the standard means for detecting the presence of SARS-CoV-2 genetic material (RNA), with negative assays from two consecutively collected respiratory specimens more than 24 hours apart and no symptoms being the benchmark for when a patient can end quarantine and return to normal activities.
However, recent research has shown that while SARS-CoV-2 RNA can be detectable with molecular testing for weeks after the onset of symptoms, it doesn’t necessarily denote the presence of infectious virus particles. In a medical records study looking at results from nearly 30,000 COVID-19 tests over a two-month period, a team led by researchers at Johns Hopkins Medicine and the Johns Hopkins Bloomberg School of Public Health gained significant insight into when virus detection also may indicate contagiousness.
The findings were published online Oct. 27 in the journal Clinical Infectious Diseases.
From March 11 to May 11, 2020, the researchers evaluated the results of repeated polymerase chain reaction (PCR) diagnostic tests for SARS-CoV-2 RNA in 29,686 nasopharyngeal swabs. The PCR assay is very specific and detects the viral RNA by accumulation of a fluorescent signal. The number of times it takes to get a positive signal is called the cycle threshold (Ct), with a low Ct score indicating a large amount of SARS-CoV-2 RNA and a high one just the opposite.
“We also placed a portion of the specimens in cell cultures to see whether or not live virus particles would grow,” says Heba Mostafa, M.B.B.Ch., Ph.D., assistant professor of pathology at the Johns Hopkins University School of Medicine and co-senior author of the study. “In that way, we could compare the Ct values with actual virus recovery in the lab to see when detected virus also was infectious virus.”
The researchers found that the average Ct value associated with cell culture growth of SARS-CoV-2 was 18.8. They also observed viral growth from specimens collected up to 20 days after the first positive result, mostly in patients who were symptomatic for COVID-19 at the time of specimen sampling. Sequencing of the entire genome from RNAs collected in the first and subsequent tests provided evidence that the same virus was seen throughout. Positive tests following negative ones had Ct values higher than 29.5 and were not associated with observed virus growth in culture.
“Our findings support the theory that low Ct values in SARS-CoV-2 diagnostic tests are associated with recoverable virus, and that RNA detection in repeated tests may indicate someone who continues to be infectious with persistent symptoms,” Mostafa says. “However, additional studies are needed to truly determine if Ct values and cell cultures can be used together to make clinical decisions, develop diagnostic strategies and identify those most likely to spread SARS-CoV-2.”
“Defining the window of time in which a COVID-19 patient can transmit the virus can help drive more effective isolation practices,” adds Andrew Pekosz, Ph.D., professor of microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health and co-senior author of the study.
THE IMPORTANCE OF PEDIATRIC SURGERY DURING THE COVID-19 PANDEMIC: ONE 4-YEAR-OLD PATIENT’S STORY
Four-year-old Ruby Rosen is a little girl with a big heart. At 6 months old, Ruby was diagnosed with a heart murmur. A visit with Johns Hopkins Children’s Center pediatric cardiologist Joel Brenner, M.D., confirmed that she had a hole in her heart. In about 75% of cases, such holes in young patients’ hearts close on their own with age. But as Ruby grew, her hole grew with her. By the time Ruby was 4, the hole was 10 millimeters, the size of a fingernail. Ruby’s cardiology team said that the hole in her heart was one of the biggest they had seen. She didn’t need emergency surgery, but would need surgery within the year. Because of the size of the hole, open-heart surgery was the only solution for Ruby. With many activities already canceled by the pandemic, her family realized Ruby wouldn’t miss out on those events during her six-week recovery period. So they decided having surgery sooner rather than later was best. “We felt like we were going to be safe at Johns Hopkins,” says Laurie Rosen, Ruby’s mom.
Ruby’s surgeon, Bret Mettler, M.D., director of pediatric cardiac surgery, along with other Johns Hopkins Children’s Center surgeons, agree that now, as well as any time, is a safe time to have surgery. “While we are living in unique circumstances with the ongoing pandemic, it’s best not to delay surgery as children’s surgery is not often considered elective,” Mettler says. He adds that delaying surgery could even be dangerous. “A child’s condition could actually worsen before surgery, which could impact the surgery once it does take place,” he says. To ensure everyone’s safety during the pandemic, the Children’s Center has put into place many policies, including patient and staff testing and increased cleaning and disinfection.
In Ruby’s case, her surgery took place in August. Mettler was able to successfully close Ruby’s heart, which meant her heart murmur also went away. Ruby is doing well, and she is proud of her new “boo-boo,” as she calls the scar from her surgery. “She’ll say ‘My heart had to get fixed to make it stronger,’” Mike Rosen, Ruby’s dad, says.
About two months after her surgery, Ruby held a pop-up lemonade stand, which offered juice boxes and individually packaged snacks, to raise money for the Blalock-Taussig-Thomas Pediatric and Congenital Heart Center. “Ruby made all the signs,” Laurie says. “You had to wear a mask, and you couldn’t eat on our lawn to keep it COVID-19 safe.” The three-hour event ended up raising $1,300 for the center.
Now that Ruby’s heart surgery is complete, her family is glad Ruby was able to have the procedure when she did. “I am so happy we did it,” Laurie says. Last week, Ruby also underwent a separate procedure at the Children’s Center to remove her tonsils and adenoids, a surgery that her doctors say needed to wait until her heart surgery took place.
Ruby, her mom, Laurie, her dad, Mike, and Mettler are available for media interviews on Ruby’s experience. Mettler is also available to discuss the importance of not delaying surgery, even during a pandemic.
Read more about pediatric surgery during the COVID-19 pandemic.
WHY HOLIDAY TRADITIONS ARE PULLING AT US DURING THE PANDEMIC — AND HOW WE CAN MAKE NEW ONES
Reasons to celebrate and good cheer have been in short supply for many during the coronavirus pandemic. So Neda F. Gould, Ph.D., understands why some people put up holiday decorations or started listening to holiday music well before the calendar turned to December.
“Traditions help us create times to look forward to and a sense of comfort and stability,” says Gould, a clinical psychologist and assistant professor in the Department of Psychiatry and Behavioral Sciences. “They help give structure to the year and to our lives.”
Social distancing guidelines mean Christmas, Chanukah and Kwanzaa celebrations will be unlike any in recent history, but Gould recommends using this unusual holiday season to start new holiday traditions, whether trying a new recipe or sending video messages to family and loved ones.
“You don’t need to compare this year to other years,” she says. “Think outside the box. What can we do to bring a little joy this year?”
Some people might find respite in the lack of holiday hustle-and-bustle, Gould adds, and those who associate the holidays with negative feelings have a chance to start fresh. If nothing else, the holiday season gives everyone a chance to reflect on what is important in life. A stressed brain tends to overlook the positive, she says.
“I think it’s really important to practice gratitude daily,” she says. “This is a perfect time of year to do it.”
Gould is available to discuss adapting holiday traditions during the pandemic, as well as how parents can talk to their children about any changes.
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.