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With new Covid variants turning up frequently, do monoclonal antibodies, which are very specific, still have a role in treatment? Infectious disease expert Stuart Ray at Johns Hopkins says new ones are continuously being developed.

Ray: Monoclonal antibody treatments are really innovative in the way we’re used them and we’ve had so many of them, we’ve never had such an arsenal of tools for dealing with the virus. The challenge is the virus as it evolves is often evolving to escape the very antibodies that we’re basing those treatments on. Because these monoclonal antibodies are mono clones of responses that somebody had, because that’s how we get them, there’s the potential for the virus to escape those. In general when we get them early we can help protect people using a treatment that is very much like what the body would do if it were working well.  :34

Ray says if you’re at risk for a poor outcome with Covid, your provider may discuss monoclonal antibody treatment with you. At Johns Hopkins, I’m Elizabeth Tracey.

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Can you trust Covid-19 tests you take at home, whether they are positive or negative? Infectious disease expert Stuart Ray at Johns Hopkins says it’s important to remember that all tests have limitations.

Ray: The humbling thing about our diagnostics is that we only see the surface, so it’s more like an iceberg. So when we see the virus become undetectable with any of our tests, it’s not gone. Thinking about HIV or hepatitis C, we have about 15 liters of extracellular fluid in our body, so that when we say that there’s less than this many per ml, you still have hundreds of thousands of viruses, possibly, in your bloodstream at that moment. With this virus because we’re sampling the nose, we’re not even sampling the internal organs, and so we don’t know how much virus the person may be harboring.  :33

Ray notes that it’s also true that some people may never test positive even though they know they’ve been exposed and may have symptoms, for the same reason. At Johns Hopkins, I’m Elizabeth Tracey.

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Paxlovid is an oral medication given to people at high risk for complications from Covid-19 infection, but now that it’s in more widespread use some are reporting a return of symptoms after they’ve finished their course of the medication. Stuart Ray, an infectious disease expert at Johns Hopkins, comments.

Ray: Many of us were not too surprised that a drug like Paxlovid would have only a transient effect, and that for some people there could be a rebound. I think we’re still learning about whether that means that Paxlovid caused a problem or whether it simply incompletely treated a problem, because you never know whether that dip would have been a worse peak and where you landed was actually where you would have been if you never used it, and whether we should have used more or a combination we’ll learn more about in the future.  :28

Ray says what is happening with Paxlovid use is much like other new medications used in novel infections. We’re on a learning curve and modifications are likely as best practices are discerned. At Johns Hopkins, I’m Elizabeth Tracey.

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Operating rooms are often very cold places, but keeping the patient warm actually helps reduce blood loss during surgery, and so does reducing blood pressure. That’s according to Steven Frank, a blood transfusion expert at Johns Hopkins.

Frank: If we can do a controlled hypotension to bring the blood pressure down to say, 20% below normal then we can reduce bleeding that way. Especially for orthopedic and spine surgeries because bone bleeding occurs and that is very dependent on the blood pressure. Your bone is very vascular, so if we can bring your blood pressure from 120/80, say down to 90/60, you can really decrease bleeding.  :31

Frank says blood supplies have been severely limited during the pandemic so a range of strategies to reduce a person’s need for transfusion are utilized. At Johns Hopkins, I’m Elizabeth Tracey.

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If you’re scheduled for surgery, you can take steps to reduce your possible need for a blood transfusion in this time of critically short supplies of blood. Steven Frank, a blood transfusion expert at Johns Hopkins, says that might start with stopping some nutritional supplements you’re taking.

Frank: Certain nutritional supplements can actually increase bleeding during surgery. There’s not a whole lot of good data on this but there’s a list of five or ten supplements that can increase bleeding. Fish oil is supposedly one of them that a lot of people take. Garlic supplements, flax seed oil. I think these effects are minimal but if you’re having delicate surgery where bleeding is important they’re going to tell you to stop taking those nutritional supplements at least a week before surgery.  :31

Frank notes that people often fail to mention the supplements they’re taking to their providers but recommends adding them to your medication list. At Johns Hopkins, I’m Elizabeth Tracey.

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When you think of blood loss accidents and operating rooms may come to mind right away, but another place where people can experience significant blood loss is while they’re hospitalized. Blood may be taken often to manage someone’s care, and Steven Frank, a blood transfusion expert at Johns Hopkins, says ICUs are at the top of the list.

Frank: Where this really matters the most is in the intensive care unit. because there they’re not just drawing five tubes of blood, they’re doing that twice a day for maybe a week. We measured the amount of blood patients lose in the ICU just for lab testing, and it turns out to be about 1% of your blood volume. It really adds up, and we started using smaller phlebotomy tubes especially in the ICU, in the operating rooms, we use these very small tubes, to reduce the amount of blood that we send to the lab.  :31

Frank says such modifications help avoid the need for transfusions. At Johns Hopkins, I’m Elizabeth Tracey.

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Blood is in more limited supply right now than it was before the pandemic, with the Red Cross citing blood donation event cancelations as key. Steven Frank, a blood transfusion expert at Johns Hopkins, says there are several strategies to help reduce the need for blood during operations.

Frank: There’s a medication called transexemic acid that reduces bleeding by about 30% and has virtually no side effects. It does that by stabilizing a clot that forms to reduce blood loss. And we can just simply keep patients warm during surgery. If we keep your body temperature normal, like 98.6 or 37 centigrade we can reduce bleeding because cold patients bleed more and just simply keeping you warm can reduce bleeding.  :32

Frank says it’s always better to avoid blood transfusion if possible, so these and other strategies may help to achieve that goal. At Johns Hopkins, I’m Elizabeth Tracey.