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Anchor lead: COVID-19 disease seems to have more than one phase, especially in those who have severe illness, Elizabeth Tracey reports

COVID-19 disease is so mild in some that they show no symptoms, while those who go on to develop severe disease seem to have at least two phases to the illness. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, comments.

Garibaldi: I think it probably is true that there’s the initial injury that happens because of the virus replicating, directly damaging the epithelial cells and other parts of the body, and then there’s the immune system’s response to it. Whether or not we find out down the road if there’s even some component of autoimmunity, that’s driving some of the inflammation we’re seeing after initial injury, I think that remains to be seen. But it certainly would make sense that in that setting, an anti-inflammatory like a glucocorticoid, could potentially shut down that secondary inflammation, and calm things down.  :29

Garibaldi says this observation may explain why the patients who seem to benefit from dexamethasone treatment are those with severe disease requiring mechanical ventilation, while those with more mild disease didn’t, as a recent study found. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: A large trial in the UK finding that a steroid can help people with severe COVID-19 also points the way to getting results quickly, Elizabeth Tracey reports

RECOVERY is the acronym for a large, randomized trial underway in the UK designed to quickly evaluate potential treatments for COVID-19. Recent results include the use of dexamethasone in patients with the disease who were on ventilators. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, applauds the approach.

Garibaldi: This is exactly the way you want to go about things if you want to get data quickly. You want it to be a large population and broadly representative of the patients who might be ill presuming with so many centers that they probably had a pretty good slice of what the population looks like. And you really want to try to do these on a larger scale because we’ve seen a lot of these small single arm trials that show promise for repurposing drugs that are already available. We’ve seen very clearly how small studies can be misleading and once you actually get larger data you realize okay, for whatever reason that one study showed a benefit but overall this is not the way we want to go.  :33

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can a steroid called dexamethasone help people with severe COVID-19 disease? Elizabeth Tracey reports

In people with severe COVID-19 disease who were on ventilators, using a steroid drug called dexamethasone reduced mortality by about a third, a very large study called the RECOVERY trial found. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, comments.

Garibaldi: What I think we’re really interested in seeing from this study is that it didn’t look like there was a benefit overall it was just in the patients with severe disease who were mechanically ventilated so does that mean that there was a harm in the other patients who got it? Whenever you start modulating the immune system in response to an infection you have to be concerned about secondary infections, other complications of steroids. We really need to dig into it to understand is this something that should be given to all patients? Is there only a subset of patients that should get it or is it really something that should become standard of care.  :30

Garibaldi says the complete data was not available when results were announced and the study was not peer-reviewed. He’s hopeful the results will bear up as they are analyzed. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: As many as half the tests available for Sars-CoV2 may not provide reliable results, Elizabeth Tracey reports

If you get tested for COVID-19, whether you suspect you might be infected or have been in the past, can you trust the results? An analysis in the British Medical Journal says maybe not, as many assays for antibodies are flawed and may provide either false negative or false positive results. Patricia Davidson, dean of the Johns Hopkins School of Nursing, comments.

Davidson: We’ve seen many examples where going too fast, not adhering to best practices has caught us short. We’ve even seen that in the scientific world, where in the race to get information out people haven’t looked at the quality of data and engaged in normal controls.  The number of assays out there is of concern because we know that the free market will sell these to people perhaps who have less capacity to discern them.   :31

Davidson is especially concerned about low and middle income countries, where these types of substandard tests are very difficult to detect and remove from the market. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How many people in the US have actually had COVID-19? Elizabeth Tracey reports

More than ten times the official number of reported cases of COVID-19 in the United States is likely a better estimate of just how widespread the infection has been, a study by the Centers for Disease Control and Prevention suggests. Patricia Davidson, dean of the Johns Hopkins School of Nursing, explains.

Davidson: They looked at samples from nearly 12,000 cases. They demonstrated that the burden of COVID-19 may be more than 10 times greater than what we thought. They collected these samples between March and May from six regions: Connecticut, Florida, Missouri, New York City, Utah and Washington state. It will be very interesting to see as these studies continue what the prevalence ends up being.   :30

The study looked at antibodies in the blood to determine exposure. Ongoing studies will look at additional sites as well as collect additional samples. At Johns Hopkins, I’m Elizabeth Tracey.

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In this next podcast, we give several tips for narrowing down journal selection. We share online resources for finding journals. We provide a detailed discussion on the steps for nursing journal selection.