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Anchor lead: People with diabetes may soon be able to inject insulin just once a week, Elizabeth Tracey reports

Many people with diabetes must use the drug insulin, which may require them to inject themselves daily or even several times a day to keep their blood sugar controlled. Now a new study demonstrates that a once a week formulation is safe and effective. Rita Kalyani, a diabetes expert at Johns Hopkins, explains the study.

Kalyani: It compared insulin glargine, which is the most prescribed basal insulin in the United States to a new insulin that was being studied in a phase two trial called insulin icodec. What makes is so exciting is that it’s given once weekly. We currently don’t have any insulins on the market that are given once weekly. We have some non-insulin injections that are given once weekly, and what we’ve seen is that there’s increased adherence. Patients like taking fewer injections, they like the flexibility.   :30

Cost of the once weekly insulin is yet to be revealed, Kalyani says, but notes that as with almost all new medications it is likely to be more expensive than alternative formulations. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Estimates are that about 10% of the US population has been exposed to Sars-CoV2, Elizabeth Tracey reports

Seroprevalence refers to looking for antibodies to an infection in a population, with the most recent study in the US finding that only 10% of us have antibodies to Sars-CoV2, and that’s a far cry from what most experts say is needed to slow down infections. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, comments.

Garibaldi: There is evidence that people’s antibodies wane over time. Depending on when you do these seroprevalence studies you could be missing people who have been exposed to the virus, are no longer mounting antibody response. In most people there are other immune memory processes that would potentially protect you against another reexposure to the virus so it doesn’t tell the whole story to know what the seroprevalence rates are but I think it certainly tells us right now that we’re, despite the many infections that we’ve had across the US, we’re not anywhere close to being able to say that this pandemic is behind us.  :30

Garibaldi says many places throughout the country are once again reporting increasing rates of infection. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Volunteers in the UK plan to allow themselves to be infected with Sars-CoV2 following vaccination, Elizabeth Tracey reports

How can you tell if a Sars-CoV2 vaccine works? Most studies inject two groups of people, one of whom gets the vaccine and the other a placebo. Then researchers wait to see whether the vaccinated group experiences less infection than the other, a process that takes some time. Now researchers in the UK say they are planning to expose some of their vaccine volunteers to the virus to see if the vaccine works, called a challenge. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, comments.

Garibaldi: It’s very difficult to do live virus challenges. This is something we don’t commonly do and there’s been a healthy ethical debate in the US about whether or not we would consider doing this for vaccine studies that are taking place here. Very interested to see what happens with those studies but there is, even though we do have some therapies against Covid-19 and we hope that these vaccines are going to be effective at providing at least some measure of protection there is some obvious risk to being in these types of studies, and very anxious to see what happens.  :29

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What accounts for an apparent decline in severity of Covid-19? Elizabeth Tracey reports

Numbers of people infected with Sars-CoV2 continue to rise nationally, yet the rates of hospitalization and death are largely declining, recent data show. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, says one factor is simply a bigger denominator, with more younger people becoming infected, but there may be another factor involved.

Garibaldi: I think the other interesting question is whether or not the size of the exposure that you have actually correlates with whether or not you get disease in the first place number one, then number two whether or not you get really sick. For many other viruses it’s true that if you are exposed to a larger amount of virus you are at higher risk of getting infected and higher risk of developing severe disease. And there’s some emerging data that suggests in areas where people are more likely to be wearing masks and are more compliant with physical distancing that we’re seeing a decrease in the number of people who get hospitalized and a decrease in the number of people who die.  :34

So wear a mask, Garibaldi says. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How many people can be infected with Sars-CoV2 but not show symptoms? Elizabeth Tracey reports

One in three people who tested positive for Sars-CoV2 didn’t have any symptoms at diagnosis and never developed any, a recent study from South Korea found. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, says there’s at least one takeaway from this study.

Garibaldi: That is the basic principle of why we all need to be wearing masks. If there’s no difference in viral shedding between someone who’s sick and someone who’s not, then we are not testing widely enough or frequently enough to know who the asymptomatic people are, we all have to be wearing masks. And not for your own safety but for the safety of the community. You’ve got to be wearing masks. And we have to be really careful in the winter because people start going inside and getting physical distancing fatigue and wanting to be with friends and family over the holidays. We have to be careful, we have to protect each other. We have to keep going.  :29

Garibaldi says that the majority of people in this study were young and therefore also at low risk for severe disease. He notes that this rate of asymptomatic infection is similar to other studies. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What can a big data analysis of Covid-19 hospitalizations teach us? Elizabeth Tracey reports

Assessment of several clinical factors and other patient characteristics can predict who might have a severe course of Covid-19 when they are hospitalized, a study by Brian Garibaldi, a critical care medicine expert, and colleagues has shown. Garibaldi predicts the data analysis approach used here will reap many benefits beyond Covid-19.

Garibaldi: One of the longitudinal benefits is we’ve gotten together this group of really, really thoughtful biostatisticians, and clinical epidemiologists, who I think are going to be able to apply these methodologies beyond Covid to other diseases. That may be the most exciting piece about this work is not necessarily what happens with Covid but what we might be able to do to inform the interface between big data feeding back into the EHR to actually create real time decision support tools that work.  :29

Such an outcome would bring to fruition long held hopes for artificial intelligence and machine learning, Garibaldi says. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can we predict the most likely outcomes for people hospitalized with Covid-19? Elizabeth Tracey reports

Using a number of factors assessed when someone comes to the hospital with Covid-19, it is possible to predict the likelihood of outcomes such as needing ICU level care, a study by Brian Garibaldi, a critical care medicine expert at Johns Hopkins, and colleagues has shown. Garibaldi says the study has additional implications.

Garibaldi: The other I think important message from this paper is that for those individuals who develop severe disease or death it can happen very quickly so the median time to developing that severe disease or that outcome was just over a day. What I think that suggests is that you have a very limited opportunity to both have these discussions with patients and their families to understand their preferences and their wishes but also suggests that there may be only a narrow window for us to do something for patients who are at high risk to try to prevent them from progressing to severe disease or death.  :30

Garibaldi hopes clinicians will use the data to help them plan in the event of further surges of Covid-19 at their facilities. At Johns Hopkins, I’m Elizabeth Tracey.