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Anchor lead: Data are mixed but concerns remain about school openings, Elizabeth Tracey reports

A reopened school in Israel has seen a wave of COVID infection after allowing kids to remove their masks, a recent report indicates. Yet studies of spread in households and the fact that kids are largely not as severely affected by COVID has empowered others to assert that schools should open. Aaron Milstone, a pediatric infectious disease expert at Johns Hopkins, comments.

Milstone: Although the risks of kids spreading it to each other may be perceived by some as low, because the complications of children may seem less risky than they are in adults, that is a little bit blind to the risks that those kids in school are imposing on their teachers and all the other staff at school that may have diabetes or other comorbidities that put them at increased risk for infection. I caution people in saying that children don’t play a role and its safe to send kids back to school because they’re not a driver of this infection.   :34

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Emerging data suggest that COVID-19 infection is just as common in kids as in other age groups, Elizabeth Tracey reports

Kids and younger people in general seem to succumb to COVID-19 infection much less often than older people and those with other medical conditions, with a recent household study suggesting that parents usually brought the infection home. Yet Aaron Milstone, a pediatric infectious disease expert at Johns Hopkins, says observational studies are bearing fruit.

Milstone: As schools are starting to require testing before students return for sports they’re finding kids that are positive, that are asymptomatic, and we know that there are kids going to the beach and coming back that are positive. We have kids in the hospital that are positive. We know that kids have this virus. And we know that anyone who has this virus is at risk of spreading. So I would really caution people from thinking that kids are not playing a role in helping spread this virus. We can prepare for the fact that when schools go back that kids will play a big role in spreading.   :34

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What does following COVID infection in families tell us? Elizabeth Tracey reports

People other than children in a household appeared to develop COVID-19 infection first and transmit it to others, a recent found. Some interpret the study to mean that children don’t readily spread the infection. Not so fast, says Aaron Milstone, a pediatric infectious disease expert at Johns Hopkins.

Milstone: In fairness the study didn’t really comment on whether kids were a big driver or not. The study just described transmission dynamics within households. But there are lots of things we don’t know, which is kids got locked down pretty quickly, much more quickly than parents did. So I think that since parents were out going to work, parents were still interacting more and their kids were at home, so kids had less exposure and parents were then bringing it home to their kids. There’s also the observation as a parent that when you’re sick you still take care of your kids but when a kid is sick you put them in a room and you tell the other kids to stay away.  :30

Milstone says this study should not be used to inform decision making regarding opening schools, as the extent to which children communicate COVID-19 to others is not known. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: More trials to establish best practices for use of dexamethasone in different populations are needed, Elizabeth Tracey reports

A trial known as RECOVERY in the UK revealed the news that many people with severe COVID-19 infection could benefit from the steroid drug dexamethasone. Namandje Bumpus, director of pharmacology and molecular sciences at Johns Hopkins, says additional studies looking at the drug in specific populations are needed.

Bumpus: With dexamethasone there’s a lot more work to be done around understanding this drug response in populations. There’s not really anything known as far as differences in the Hispanic population. But as far as African Americans there are studies pointing to differences. There’s published work looking at black people that are asthmatic versus people that are non-asthmatic, basically showing that black people required more dexamethasone to get this activation effect you would expect from the drug.  :34

Bumpus says such studies are underway in the US. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Overdose deaths are increasing along with COVID-19 mortality, Elizabeth Tracey reports

Deaths from drug overdoses are reaching record levels even as those from COVID-19 continue to climb, CDC data reveal. Eric Stain, a drug abuse expert at Johns Hopkins, says there are many factors to consider.

Strain: Overdose deaths are up, and in some respects it seems like these death rates are getting obscured with the appropriate concerns about COVID. The overdose deaths are also concerning because we’re seeing more stimulant overdose deaths. So methamphetamine, cocaine. Those rates are going up. Now it may be that they’re combined with opioids but there’s some concern that we’re so focused on opioids that we’re missing the fact that methamphetamine use and cocaine use are going up as well.  :29

Strain asserts that many of these overdose deaths are likely deaths of despair, or intentional overdoses. He says that programs at Johns Hopkins and elsewhere are working hard to identify risk factors and barriers to treatment. I’m Elizabeth Tracey.

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In this next podcast, we define a root cause analysis. We share the tools used to perform the root cause analysis. We also discuss an example as a way to apply the project management tools. 

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Anchor lead: Antibody treatment may point the way to why some people with COVID-19 get critically ill while others don’t, Elizabeth Tracey reports

Antibodies don’t tell the whole story when it comes to the development of critical illness in people with COVID-19. Arturo Casadevall, an expert in antibody treatment of infectious diseases at Johns Hopkins, notes a curious phenomenon.

Casadevall: One of the things that is fascinating is, if you get sick with this and you’re in the ICU, these people have antibody to the virus. But they don’t clear the virus. If you give them convalescent plasma from somebody who’s recovered, they clear the virus. And what’s emerging now is that the initial response is not very good. There are some highly neutralizing antibodies that basically stop the infection dead in its track. Several of these monoclonals have now been made. The problem is going to be ramping up production.  :30

Casadevall notes that for low and middle income countries, making monoclonals in a laboratory would be far too expensive and require expertise that may not exist, but the convalescent plasma treatment is much simpler and more practical. At Johns Hopkins, I’m Elizabeth Tracey.