Repeat COVID in Marines; Activity and Hearing Loss: It’s TTHealthWatch!

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TTHealthWatch is a weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine, and Rick Lange, MD, president of the Texas Tech University Health Sciences Center in El Paso, look at the top medical stories of the week. A transcript of the podcast is below the summary.

This week’s topics include COVID reinfection among Marine recruits, meditation for post-traumatic stress disorder (PTSD) in veterans, hearing loss and physical activity in elders, and COVID transmission in Israel after national vaccination.

Program notes:

0:38 If you’ve had COVID can you get it again

1:35 Followed with repetitive testing

2:32 Fewer neutralizing antibodies

3:26 Hearing loss and physical activity in older adults

4:28 Less time spent in both vigorous and light activity

5:30 Tied to cognition

6:20 Does national immunization provide herd immunity?

7:23 Great evidence for benefit of national program

8:25 Need a number of strategies

9:25 Getting ahead worldwide

9:40 Meditation and PTSD

10:40 Look at own relationship to their trauma

11:25 Didn’t help PTSD

12:16 End

Transcript:

Elizabeth Tracey: How does hearing loss impact on physical activity in older adults?

Rick Lange, MD: Does immunizing a nation provide herd immunity?

Elizabeth: Can mindfulness meditation help veterans with post-traumatic stress disorder (PTSD)?

Rick: And if you’ve had COVID, how likely is that you’ll get it again?

Elizabeth: That’s what we’re talking about this week on TTHealthWatch, your weekly look at the medical headlines from Texas Tech University Health Sciences Center in El Paso. I’m Elizabeth Tracey, a Baltimore-based medical journalist.

Rick: And I’m Rick Lange, president of Texas Tech University Health Sciences Center in El Paso, where I’m also dean of the Paul L. Foster School of Medicine.

Elizabeth: Rick, of course, one of the questions you posed is at the top of mind for many, many people: if you’ve had COVID, can you get it again? This is in a study that’s in the Lancet Respiratory.

Rick: In particular, this looked at a younger age group, specifically Marine recruits, but it’s a large number, so let me walk through it. Again, they tried to ask and answer the question whether young adults who are already infected with COVID are at risk of subsequent infection because that really is kind of uncertain. We hear about case reports, but they haven’t really been put in numbers.

They looked at U.S. Marine recruits age 18 to 20 years and here’s what happened. Before they went to basic training, they asked these recruits to self-isolate at home for 2 weeks. Then they brought them in for basic training and they isolated them for another 2 weeks, and then they went into basic training for 6 weeks.

So they tested them when they first came into basic training, looking for antibodies, that is did you have an infection or did you not in the past, and then they followed them during the 6 weeks — at 0, 2, 4, and 6 weeks — with repetitive testing looking for PCR evidence that they had active infection.

It was a large number of recruits. It was over 2,800, and not surprising, most of these were men. Over that 6-week period, for those that had not had previous COVID infection, about 48% of them became infected during basic training. For the small group that had had COVID infection, it was only 10%. That is that having a prior infection was about 80% effective in preventing you from getting reinfected. Now, it wasn’t 100%, but it was still pretty good.

Elizabeth: Hmm, 80%. I’m not sure that I’m really all that comfortable with that number as a means for achieving immunity.

Rick: Elizabeth, you’re absolutely right. That’s why we recommend if you’ve had a previous COVID infection that you still get vaccinated, because here’s what we know. You have a higher antibody titer after vaccine than you do after infection. It seems, by the way, these individuals that got reinfected were likely to have a lower antibody titer and fewer neutralizing antibodies, so the antibody titer in these young recruits did, in fact, translate to how resistant they were.

So if people have been infected, I don’t want them to think, “Oh, I’m home free. I can’t get infected again.” No, that’s not really the case. You can, and what they do need to do is they need to get vaccinated.

Elizabeth: I would just note, of course, that what we’re seeing is a good deal more infection among younger people right now, all over the world, so younger people need to be concerned about this particular risk.

Rick: They do, Elizabeth, and you’re absolutely right. In fact, most of these individuals were asymptomatic or relatively mild symptoms because they were young individuals. This is young men aged 18 to 20 years of age, so how generalizable this is for the older population is still a little bit uncertain. But what you can say is in relatively young individuals that you expect a robust immune response, having a previous COVID infection does not absolutely protect you from getting reinfected.

Elizabeth: Hmm. Let’s turn to JAMA Network Open. This study is taking a look at the issue of hearing loss and whether that might impact on older adults’ physical activity. The reason that I thought this study was interesting is because we’re paying a lot of attention to hearing loss in older folks, and as you know, we’re about to be able to purchase hearing aids over the counter. There is also a lot of movement afoot to start reporting hearing loss just as we report things like blood pressure, and cholesterol levels, and blood sugar. Those things are hoping to be reported in this thing that’s known as the Pure Tone Average, or PTA, and it’s a reasonably easy number to gather.

So in this study, they had 291 participants who had some hearing loss. They also took a look at, “Well, what are they doing with regard to activity?” They found out that hearing loss versus normal hearing was significantly associated with less time spent in this moderate to vigorous physical activity by about 6 minutes a day, less time spent in light-intensity physical activity by almost 29 minutes per day, and more time spent, unsurprisingly, in sedentary behaviors.

These things, as we know, are associated with a lot of deleterious health impacts, and so they predict or they say that this magnitude of hearing loss with physical activities is equivalent to a little bit over 7 years of accelerated age if you don’t do your moderate to vigorous activity, about 6 years if you don’t do the light-intensity physical activity, and almost 11 years for the fact that you just kind of sit around. And so this is all part of this constellation of things, I think, that are helping us to predict what we call healthy aging.

Rick: I appreciate that term, Elizabeth. As we’ve talked before, about two-thirds of individuals over the age of 70 will experience some hearing loss, and we know that physical activity is tied to things like quality of life, a better cognition, a better cardiovascular health, a lower mortality overall.

So there’s an association of hearing loss and activity. It doesn’t prove causation and the other thing it doesn’t give us any insight into is exactly why that is. Is it because of social isolation? We know these people are oftentimes more depressed with less physical activity. Are they concerned about falling? Are they having to spend so much time aware of their surroundings that they can’t spend as much time exercising and doing so freely?

The other thing that’s really important is, if we improve their hearing, will it improve their physical activity? If you give them hearing aids, will this lead to better activity? At the very least, what it should signal primary care providers is when you get someone with a hearing loss is ask about their physical activity and what can we do to increase it to improve the other things that we talked about?

Elizabeth: Exactly. Let’s turn to your next one. That’s in Nature Medicine.

Rick: So Elizabeth, I teed this up as, “Does a national immunization program provide herd immunity?” And we’re going to talk specifically about the national immunization program in Israel because that was one of the countries to get out of the block very early on to immunize individuals.

They took this on in late December of 2020, so that by within 2 months, about 81% of the eligible individuals had received two vaccines already, so that they got on this extremely early, and they used the Pfizer vaccine. They ask a simple question, “How has that affected the COVID dynamics in their country?”

Here is what they discovered. A little over 2 months after initiation of the vaccine campaign, with 85% of individuals older than 60 already vaccinated with two doses — this is by February of 2021 — there was a 77% drop in cases, a 45% drop in positive test percentage, a 68% drop in the hospitalizations, and a 67% drop in severe hospitalizations compared to peak values. I think this is great evidence that on a national level, a program that does a great job of immunizing, especially the most vulnerable individuals, significantly impacts COVID results in that particular country.

Elizabeth: Okay. So we’ve got a hodgepodge of things going on worldwide with regard to immunization. Israel is blessedly a pretty small country with a population that might be more likely to buy into public health efforts than other countries might be, so compare — and I know it’s speculation on your part — those results with what we’re experiencing right now in the U.S., for example.

Rick: Yep. What Israel did was really amazing. They made the vaccine available early on. They targeted high-risk groups. They made sure there was plenty of supply and that people were interested in getting the vaccine, so all of those things tie into that.

Now, they had lockdowns during this particular time, but what they could show is that the lockdowns weren’t really responsible for this decline. They immunized different age groups at different times, depending upon how much vaccine became available. It took them 2 months, but they noticed that the ones that experienced all these benefits were those that got vaccinated, not those involved in a lockdown.

So Elizabeth, I agree with you. It’s not just having a vaccine program. It’s making sure it’s rolled out, it’s rolled out quickly, it targets groups, they accept it, and then you move through the entire population.

Again, it’s a relatively small country. However, you could generalize these to large metropolitan areas. You could generalize it to states or other countries of similar size as well. I do think it speaks to the fact that you can significantly impact the overall outcome with herd immunity by having a national program that’s effective.

Elizabeth: And of course, I would be remiss in not pointing out that with regard to this issue of herd immunity, if we adopt Brazil as a model and we see the absolutely rampant transmission that’s occurring there right now — in spite of the fact that they had very high levels of natural infection earlier in the pandemic — my concern is that there’s so many variants that are popping up all over the place that getting ahead of this in a significant way worldwide is going to be a real uphill battle.

Rick: The more infections there are and the longer we drag out the vaccination programs, the less robust the results will be in terms of efficacy.

Elizabeth: Yeah. Let’s turn, then, to JAMA Network Open, back to that, to something that I think is timely not just for these particular folks in this study, but for probably everybody. This is a look at loving-kindness meditation versus cognitive processing therapy for PTSD among veterans.

This is a group, of course, who do suffer from post-traumatic stress disorder a lot and this is a randomized non-inferiority trial looking at both PTSD and depression at baseline, post-treatment, and 3- and 6-month intervals of follow-up. Each intervention was 12 weekly, 90-minute group sessions of this particular strategy, whether that was the cognitive or the mindfulness meditation strategy.

Just as, maybe, education for listeners, loving-kindness meditation is silent repetition of phrases intended to elicit feelings of kindness for oneself and for others, while the cognitive processing therapy (CPT) has them really take a look at their own relationship to their trauma.

There were 184 veterans. A total of 66% completed the entire 6-month follow-up. Basically, at the end of the day the mindfulness meditation was more effective in reducing the depression scores than the cognitive processing therapy, and I would respectfully submit is probably a practice that could be carried on by the individual long-term and hopefully result in benefits over the long term also.

Rick: Elizabeth, again, they looked at two components, the PTSD component and also the depression. As you mention, it looked like loving-kindness meditation was a little bit better than cognitive therapy for treating depression. There was no difference between the two with regard to PTSD, and in fairness, the effect was fairly modest. But I agree with you, Elizabeth, in that the CPT requires trained individuals that focused on the trauma and the stressors and how to overcome that, whereas the loving-kindness meditation can be performed really without trained professionals.

It’s disappointing that the effects were modest. It’s disappointing that a third of individuals couldn’t complete the therapies, but nevertheless, anything that we can do to help individuals overcome PTSD I think is beneficial.

Elizabeth: Yeah. Absolutely. On that note, that’s a look at this week’s medical headlines from Texas Tech. I’m Elizabeth Tracey.

Rick: And I’m Rick Lange. Y’all listen up and make healthy choices.

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