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Community-Based Asymptomatic COVID Testing; Particulate Matter in Lungs


TTHealthWatch is a weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine in Baltimore, 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.

This week’s topics include community-based asymptomatic testing for COVID and hospitalizations, a computerized driving program for kids with ADHD, particulate matter in the lungs and immune response, and organ donation and motorcycle rallies.

Program notes:

0:40 Community-based COVID testing and hospitalizations

1:40 In those without symptoms

2:42 Conducted in a community with higher deprivation

3:46 Inhaled particulate accumulation with age

4:48 Lymph nodes have accumulated particles

5:45 Any way to get rid of it?

6:10 Motorcycle accidents and organ transplants

7:13 More when motorcycle rallies taking place

8:14 Need to educate about organ donation

9:15 Much more likely on a motorcycle

9:33 Training teen drivers with ADHD

10:35 Tried to distract the kids

11:35 Switch to skill training

12:54 End

Transcript:

Elizabeth: Can we test people with no symptoms for COVID and keep many more people out of the hospital?

Rick: Air pollution and dysfunction of lung immune system.

Elizabeth: Is there an upside to fatal motorcycle crashes?

Rick: And making teens with ADHD better drivers.

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: We will turn straight to the BMJ. This is a study taking a look at community asymptomatic rapid antigen testing and its impact on their COVID-19 related hospital admissions. It was conducted in Liverpool between November 2020 to January 2021.

They had this intervention called COVID SMART — and SMART, the acronym, stands for Systematic Meaningful Asymptomatic Repeated Testing, which is a voluntary, open-access, supervised, self-testing scheme. They use lateral flow devices — the same things that we’re very familiar with for pregnancy tests, for example — Liverpool, a city of about a half a million people, and then they compared that with what they call the synthetic control population from the rest of England.

They did this community-wide testing. They provided these kits to people and they said it was totally voluntary, “Hey, test yourself, even when you don’t have any symptoms of COVID-19.” They saw a 43% reduction in COVID-19-related hospital admissions in Liverpool compared with their control population. That’s pretty impressive.

Rick: This was supervised self-testing, as you said, with a lateral flow device. Following that, individuals who tested positive were instructed to isolate for 10 days and also to take a confirmatory PCR test. It was just a little bit more than just the self-testing. The results were immediately available and then, if positive, they were instructed to self-isolate. It was that — not the self-testing itself, but the isolation — that I think resulted in decreased hospitalizations. Your thoughts?

Elizabeth: No question about that. They do cite previous research that demonstrates that asymptomatic transmission of the virus accounts for more than half of transmissions in a community that may arise in those folks who don’t have symptoms, whether those are pre-symptomatic or they never get symptomatic when they are infected.

Rick: The nice thing about this particular study is it’s conducted in a community that actually has higher levels of deprivation, population densities, and higher proportion of people with chronic disease. It wasn’t tested in a high-affluent area, but actually in an area where in the 7 weeks prior to the testing they actually had more positive COVID cases in the surrounding areas.

Elizabeth: Yes. They did note that although this program was popular overall, there was lower uptake among Black, Asian, and ethnic minority groups in the neighborhoods that were identified as deprived and in areas that were some distance from the test sites, and also including populations who are less confident in using Internet technologies such as some older people.

Rick: It would be nice to repeat this study in the current situation.

Elizabeth: I agree. They do also say that this community was motivated by shared identity, civic pride, and a desire to protect others. I’m afraid I’m a little cynical about the possibilities if we try to apply this to other populations.

Rick: Let’s move from this study. Since we’re talking about infection of the lung, let’s turn to the Nature Medicine article that looks at inhaled particulate accumulation with age and how it affects the immune function, and the architecture of the lymph nodes in lung tissue.

There is a disproportionate increased impact of lung infections and cancer in individuals over the age of 65 — by the way, that’s going to be 20% of the population in the next 30 years. In fact, if you look at mortality from COVID infection, if you’re over 75, it’s a 80-fold greater mortality than in younger adults.

What is it about the immune system in older adults that makes them more susceptible? What these investigators did was they took 84 organ donors aged between 11 and 93 years old, and they looked at the lymph nodes in the lung and in the gut.

Now, these lymph nodes are where the accumulation of white cells — B-cells and T-cells that fight infection — are located. If you compare the lymph nodes in the lung to the lymph nodes in the gut, the ones in the lung have a higher likelihood of being black or having particulate matter, whereas the lymph nodes in the gut really don’t have those at all.

The older the individuals were, the more likely they were to have particulate matter in the lymph nodes that could quantitate that. Then when they looked at the specific white cells, the T-cells and the macrophages that had this particulate matter, they had decreased immune capability.

It’s the author’s belief that this chronic accumulation of particulate matter adversely affects immune function in the lung and that, as part of the aging process, is what makes older individuals more susceptible to other infections and to cancer.

Elizabeth: We’ve talked so much about particulate matter. We know that it is increasing worldwide and that it’s impacting people who are younger. Gosh, I’m thinking of studies where we’ve described much higher rates of disease in people who live proximal to highways, for example. My concern here is, OK, if we do note that this resident particulate matter, if you will, is problematic, is there any way we can get rid of it?

Rick: This particulate matter that is in the lung, but not the gut, is basically an airborne disease. One has to decrease pollution in the particulate matter to affect this condition.

Elizabeth: But you can’t think of anything that would actually get rid of it once it’s there?

Rick: Not once it’s there.

Elizabeth: Well, my guess is that having described this mechanism, we’re going to be seeing a whole lot more about what to do about that. Let’s turn to JAMA Internal Medicine. I said, is there an upside to fatal motorcycle accidents?

This is a study that’s a little bit daunting. They take a look at major motorcycle rallies taking place in the United States and the rate of organ transplantation. They look at donors age 16 years or older involved in a motor vehicle crash and recipients of organs from these donors from March 2005 to September 2021.

They had about 11,000 organ donors. About 71% of those were males and their age was about 32 years. They had 35,000 plus recipients of these organs, 64% of whom were male and their age was just shy of 50 years.

When they looked at the data relative to these motorcycle rallies, they found that there were 21% more organ donors per day and 26% more transplant recipients per day when the rallies were taking place compared with 4 weeks before and after the rallies in the regions where they were held. What’s clear is that there are a whole lot more motorcycle fatalities during big motorcycle rallies and that it does result in a higher rate of organ transplantation.

Rick: It really is a sobering study. It’s a serious problem in the U.S. For example, in January of this past year, there were more than 106,000 patients on a solid organ transplant waiting list. Most patients waiting for an organ donation don’t get it.

One donor has the potential to save up to eight lives depending on how their organs are allocated: two kidneys, two pieces of the liver, two lungs, the pancreas, and the heart. If the organs from one donor are distributed to six different recipients, that one death is able to provide almost 56 additional life years for the organ recipients. That’s not even talking about using tissue donations — that’s bones, corneas, heart valves, cartilage, and other tissue that can help people like burn patients.

We need to educate individuals just around the U.S. on the importance of organ donation. We have an opt-in system. A lot of countries have an opt-out system. When you go from opt-in to opt-out, the donation rate increases from about 21% to as high as 76%.

Elizabeth: Right. So let’s just fill in the blanks just a little bit. Our opt-in system is when you get your driver’s license you say, “If I die in a motorcycle accident or another kind of motor vehicle accident, I allow my organs to be transplanted.” Other countries require you to say the opposite: “I do not want my organs to be transplanted,” and they have experienced a dramatic increase in the availability of organs.

A couple other things I would note. They do say that alcohol was involved in a significant number of these crashes and also this lack of helmet use. Helmet use can prevent almost 40% of fatalities relative to motorcycle crashes.

Rick: You’re much more likely to have a fatal accident on a motorcycle than in a car, and especially if it’s associated with alcohol use and the lack of a helmet as well.

Elizabeth: Finally, speaking of driving, let’s turn to the problem of teenagers who have ADHD. Is there anything we can do to help them pay more attention while they are driving?

Rick: This has to be important because motor vehicle accidents are one of the leading causes of death among teens. Teen drivers are four times as likely to be involved in a collision as adult drivers and teens with ADHD are twice as likely as those teens without ADHD to be in a collision. What’s been noticed is that teens that have ADHD are more likely to be inattentive during driving, take their eyes off the road.

They took 76 teens between the ages of 16 and 19 that had ADHD. They randomized them to either this special computerized training, and the other is just routine driver’s education. This computerized skills training was designed to reduce long glances lasting more than 2 seconds away from the roadway.

They did a simulation and they had a roadway they were looking at, they had instructions below it. If their eyes deviated from the roadway for more than 3 seconds, there was an auditory sound, just to tell them, “Hey, you’re not paying attention,” to get their eyes back on the road. It got progressively more sophisticated in how they tried to distract the kid and get their eyes on the road with five sessions.

When they looked at the kids 1 month and 6 months after they had the specialized training or not, those that had the specialized training had about 16 to 17 glances away from the road compared to those that didn’t have training where it was 27 to 28. They also looked at whether they stayed in the lane or not. The kids that had the specialized training were more likely to stay in the lane and not swerve.

They evaluated the real driving over the following year after the training and those that have the specialized training had a 40% less likelihood of collisions or near collisions. This shows that the specialized training in teens with ADHD was effective.

Elizabeth: Let’s just mention this is in the New England Journal of Medicine. This sounds fabulous to me because kids, at least in my exposures to them so far, really enjoy these kinds of video interventions and they play lots of them already. Gosh, wouldn’t it be great if we could switch them to things that produce skills that were helpful? We have seen that also in training things for surgeons in manual dexterity, I think that there is a role for these.

Rick: This is something they are very familiar with. Instead of playing games, this actually trains individuals to be more attentive to the road with real-world results. I agree with you, Elizabeth. The other thing is this is not very expensive to do. This is a program that can be rolled out to hundreds and thousands of teens with ADHD. All they have to do is have a computer to be able to look at it.

Elizabeth: It sounds to me like all teenagers, and maybe even those of us who have been on the road for longer and may require periodic refreshing of our skill set, ought to be doing this.

Rick: It will be interesting in the future if we can have cars that actually track our attention or inattention and record it on a regular basis. If we do that, then we’ll be able to say, “If you’re not paying attention, maybe we need to do something to help correct that.” That might be the car of the future.

Elizabeth: We may be around talking about it. 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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