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Mobile stroke units, much like emergency medical service trucks, enable  responders to evaluate and begin treatment for stroke in the field, with a recent study demonstrating they improve outcomes. Michele Johansen, a stroke expert at Johns Hopkins, says there are a few things to consider before a full scale investment in mobile stroke units.

Johansen: Stroke in general has done a great job training EMS personnel. They know how to screen stroke, they know what to do with a stroke, they know how to get stroke to an emergency room quickly. What the mobile stroke unit has that’s different from the EMS truck is advanced technology and advanced staffing. The advanced technology is a CT scanner. Unless the cost comes down that’s something to really think about before we start throwing out all these mobile stroke units. You’re going to need somebody like a tech for the CT to be in the mobile stroke unit to do the CT. That’s one of the key components of getting someone to the emergency room quickly, is making sure that they haven’t had a bleed.  :33

Johansen says she is concerned about personnel shortages in hospitals already, and assigning someone to a mobile stroke unit may make matters worse. At Johns Hopkins, I’m Elizabeth Tracey.

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Children under twelve remain at risk for Covid infection, and even older children who can’t receive the vaccine or are immunocompromised are also at risk. Anna Durbin, an infectious disease expert at Johns Hopkins, says there are steps parents can take to protect their children.

Durbin: The family is the wall surrounding the children. So you want to make sure of course that you’re vaccinated, people they come in contact with are vaccinated. It’s really really difficult if you’re going to public spaces and you don’t know who’s vaccinated and who’s not vaccinated. I am cautiously optimistic, as kids under 12 get vaccinated, and we have vaccine mandates roll out that we are going to see decreases. And I think delta is slowing, I think that we’re starting to see that it’s peaked. It’s waning, but we still have I think probably six to eight weeks before we might feel safer.  :33

Durbin counsels patience as vaccines for younger children are evaluated. At Johns Hopkins, I’m Elizabeth Tracey.

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Mu is just the latest Covid-19 variant that’s drawing the attention of many, with potentially worrisome mutations that may predict how infectious it might be.  Anna Durbin, an infectious disease expert at Johns Hopkins, says current vaccines should still provide pretty good protection against mu.

Durbin: We know that with mu the antibody responses are similar to beta. Meaning that the antibodies don’t work as well against mu just like they did not work as well against beta. That being said however, we know that people who were vaccinated, part of clinical trials in South Africa where the beta variant was spreading, efficacy against infection was lower, so about 65%, but the efficacy against severe disease and hospitalization was about 95%.   :29

Durbin says that while the best case is being able to avoid infection entirely, avoiding severe disease and staying out of the hospital are very good outcomes. At Johns Hopkins, I’m Elizabeth Tracey.

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When enough people in certain geographic areas choose not to be vaccinated against viral diseases, outbreaks happen. We’ve been seeing this nationally with measles for years, and Covid-19 is no exception. Anna Durbin, an infectious disease expert at Johns Hopkins, explains.

Durbin: It’s all about who’s susceptible to infection. You can have in your state for instance 70% of adults vaccinated but you could have 90% of those adults in one place. When it burns through, when it gets transmitted through and it now longer has susceptible people to infect we see reduction in infections. Unfortunately then, delta came in which was more highly transmissible, so it was able to infect when alpha wasn’t. It was able to infect more people at a time than alpha.  :31

Durbin notes that because it isn’t possible to determine who’s vaccinated and who’s not, remaining vigilant is your best strategy. At Johns Hopkins, I’m Elizabeth Tracey.

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The mu variant of Covid-19 is spreading, with new variants cropping up all the time. Anna Durbin, an infectious disease expert at Johns Hopkins, says although variants are concerning, the beauty of mRNA vaccines is the ease with which new ones can be created.

Durbin: They’ve already made variant specific mRNA vaccines. It’s really easy to do. As soon as you know the sequence you can redesign your RNA insert. The other thing that they’ll do in terms of how you license it, it’ll be looking at antibody response, so it’ll be immune bridging trials to show that the variant antibody titers are within statistically specific designed range of the other mRNA vaccines and then they’ll be good to go.  :31

Durbin says other strategies such as masking are also a good idea since as long as the virus keeps infecting people new variants will continue to emerge. At Johns Hopkins, I’m Elizabeth Tracey.

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The best strategy to mitigate Covid-19 infection is still prevention with vaccines, but if you develop the disease, new oral medicines are poised to take their place in treatment. Mark Sulkowski, an infectious disease expert at Johns Hopkins, explains.

Sulkowski: There’s still I think a strong push for oral antivirals, both a protease inhibitor in development from Pfizer and a drug that acts on the polymerase, molnupiravir, that Merck is helping to develop. I think both of those hold promise for early treatment and prevention. And there is a an EUA for the Regeneron monoclonal for prevention. I think the challenge is just the rollout of that. You’re now talking about people who do not have Covid-19, and figuring out how we’ll administer that.  :30 

Sulkowski says Merck issued a press release describing its new medicine, but notes that no studies have been published on the drug yet, but he welcomes new options to manage Covid-19. At Johns Hopkins, I’m Elizabeth Tracey.

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Many countries have or are in the midst of rolling out third doses or boosters against Covid-19, even as the World Health Organization decries the practice. Anna Durbin, an infectious disease expert at Johns Hopkins, says while such a strategy might keep some well, it’s not the way to stop the pandemic.

Durbin: If you want to stop the spread of delta, if you want to stop the emergence of new variants giving booster shots is not the way to do it. We have to get unvaccinated people vaccinated. I think unfortunately the discussion around booster shots has been a bit of a distraction and has moved the discussion away from what do we need to do to get unvaccinated people vaccinated. Will a booster help your immune system? Yes. Will it raise your antibody titers? Yes. Do you absolutely need it? Most people probably not.  :33

Durbin says those with special needs such as transplant recipients may need a third dose to produce any antibodies. At Johns Hopkins, I’m Elizabeth Tracey.