Our internal hardwiring known as our nervous system is divided into a steady state mode, known as the parasympathetic arm, and the fight or flight mode, known as the sympathetic arm. Karen Swartz, a psychiatrist at Johns Hopkins, reminds us that for almost two years now we’ve been living on high alert.

Swartz: Many have been living in a fight or flight mode for months and months at a time. And that’s taking a toll, both physically and psychologically. So how can we manage this high level of stress? One important step is to manage expectation. We need to recognize that we’re all going to need to adapt, to make changes and to deal with the very different circumstances that we’re in. We also need to be better about identifying the support and resources we have, and actually utilizing them.  :27

Swartz says most of us enjoy a much more robust network of support than we may recognize. Beginning with family and friends may allow your entire circle to realize that these emotions are more common than not at this point in the pandemic. At Johns Hopkins, I’m Elizabeth Tracey.


Disasters have been happening for a long time now, and so have studies of them. Karen Swartz, a psychiatrist at Johns Hopkins, reminds us that we can view our current predicament through the lens of history, and perhaps regain some calm.

Swartz: Any time there’s a disaster, whether it’s a hurricane, or a global pandemic, there’s a predictable psychological response. Early on the entire community will rally to the challenge. This early positive response, with an improvement in psychological wellbeing, is predictably followed by a period of exhaustion and disillusionment when you have a disaster that’s lethal, that goes on for a long time, that has a lot of ambiguity. That’s when you have a disaster of uncertainty. This combination is a setup for the greatest number of psychological consequences.  :33

As increasing rates of mental illness worldwide attest, even if you don’t become infected with Covid-19 you may still experience threats to your health. At Johns Hopkins, I’m Elizabeth Tracey.


Some people quip that change is the only constant in life, and that’s demonstrably true about Covid-19 and the pandemic. Karen Swartz, a psychiatrist at Johns Hopkins, says that very quality is one of the greatest challenges for most of us in dealing with it.

Swartz: Change itself is challenging. Some people who are more extroverted embrace change and enjoy change. Those of us who are more introverted find change inherently challenging. There are other factors that make change harder to manage. These include whether it’s a short term or a chronic issue, whether it’s expected or unexpected, or whether it’s a choice or imposed. Unfortunately, the Covid pandemic incorporates all of the most challenging elements: at least initially was unexpected, it’s been chronic, and it feels very much imposed.  :31

Swartz says simply being aware of one’s own response to change can be helpful, and notes that other coping strategies like limiting one’s attention to both news and social media may be good strategies. At Johns Hopkins, I’m Elizabeth Tracey.


The majority of cancer studies researchers attempted to repeat in a recent analysis were not reproducible, a recent paper found, with 59% of 50 attempts failing. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says trying to validate results is a laudable goal, but it’s very difficult to execute. A major issue is pressure on researchers to publish their findings.

Nelson: I do worry about publishing. If you look at the number of articles published, it’s really been continuing to go up. Things that are clearly inappropriate, plagiarism, it’s a little harder to do with the search tools that are present where you can go search out borrowed text. Occasionally you’ll see things published about the level and degree of fraud and misleading publications. There’s room for improvement, and I think one thing that this group should be lauded for was trying to take this on.   :28

Biomedical research is largely funded in the US and many other countries using public funds, so attempting some sort of oversight is certainly indicated. At Johns Hopkins, I’m Elizabeth Tracey.


What will the drop in cancer screenings teach us about overdiagnosis and overtreatment? Elizabeth Tracey reports

Colonoscopies, prostate biopsies, CT for lung cancer screening, all down as a result of the pandemic. More worrisome is the drop in cancer diagnosis. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says over the next several months what may be revealed is how many times cancers that weren’t going to cause a problem are detected.

Nelson: There’s always this concern around the use of screening techniques and technologies of an overdiagnosis. Once we find them then we find ourselves having to chase after and manage them, so this is in a sense a real world experiment. As the pandemic waxes and wanes, paying attention to other healthcare issues, including wellness, or health preservation and promotion activities, remain important, and many of them create and improve resilience for Sars-CoV2 and Covid-19 kind of infections and syndromes.  :30

Nelson especially encourages those with a family history or other risk for cancer to resume routine screening activities. At Johns Hopkins, I’m Elizabeth Tracey.


Both cancer screening and diagnosis are down quite a bit from prepandemic levels, a study of Veterans Administration hospitals shows. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, reviews the data.

Nelson: There was a significant distraction in the normal utilization of healthcare resources. A lot of that included cancer screening and some of the surgeries. This takes stock of what the impact has been. Colonoscopies down 45%, prostate biopsies looking for prostate cancer down 29 to 30%, screening CT scans for lung cancer among heavy smokers down 10%. New cancer diagnoses were down 13 to 23%. Could that be good? Well if there was less cancer it could be good. If it’s just we’re detecting it less that’s obviously not going to be good.  :33

Nelson acknowledges safety concerns but notes that routine health maintenance activities are important to continue, especially cancer screenings. At Johns Hopkins, I’m Elizabeth Tracey.


Many women with ovarian cancer are initially treated with surgery and a type of chemotherapy containing platinum. Now a new study shows that if the cancer returns, some women will benefit from another surgery as well as chemotherapy. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, explains.

Nelson: Sometimes the cancer recurs, and if it recurs six months or more later, the thought is that there may still be some mileage that can garnered out of this platinum kind of chemotherapy regimen. What this did was ask the question whether you were going to get that kind of chemotherapy anyway, they randomized to go in and remove as much of the cancer as they could see and find. What they found was there was an advantage to going in and surgically removing the cancer particularly if they could completely remove all the cancer they could see. The advantage was people lived longer.  :31

Nelson notes that many additional agents are being developed for ovarian cancer that are likely to improve survival still further. At Johns Hopkins, I’m Elizabeth Tracey.