Two Brothers, Nurses, Work Side By Side in COVID-19 ICU | U.S. News Hospital Heroes

After they graduated from high school in North Carolina, Guillermo Vargas and his brother Jonathan wanted to join the Marines. The Mexican immigrants were prepared to serve the U.S. by donning military fatigues and battling enemies overseas.

The Marines turned the Vargas brothers away, Guillermo and Jonathan say, because of their immigration status. Born in Mexico and brought to the U.S. as children without documentation, the brothers were approved for a program that shields kids like them from deportation. But the program doesn’t confer all the rights of citizenship or permanent legal residency.

So today, the brothers serve on a different front line – in the battle against COVID-19. Guillermo, 32, and Jonathan, 30, are both registered nurses in the intensive care unit at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina.

Instead of wearing camo and carrying military-grade weapons to battle flesh-and-blood enemies, the brothers don personal protective equipment – disposable gowns, gloves and masks – to protect themselves against the highly transmissible novel coronavirus.

The daily battle they wage while providing treatment to COVID-19 patients in the ICU exacts a heavy emotional and mental toll on the brothers.

Several times, both siblings have cared for patients over a period of weeks, getting to know them and the relatives who call to check on their loved ones. Some COVID-19 patients have briefly improved, only to quickly deteriorate and die. “It does feel like you’re in a never-ending battle, the way the pandemic is going right now,” Jonathan says. “You’re fighting for people’s lives, and patients keep streaming in. We’re exhausted, we’re tired, we’re mentally burned out.”

Jonathan recalls being present as another nurse held an iPad so a COVID-19 patient near death could speak to his relatives one final time. “It was pretty difficult,” he says. “The patient was taking his last breaths surrounded by strangers.” Watching COVID-19 patients die without the company of loved ones “is one of the hardest things we do,” Guillermo says. “The first thing you think about is your family. You think ‘this could be my mom, my dad, my brother.’ It’s very sad.”

In the first weeks of the pandemic, Wake Forest Baptist didn’t allow family members to visit COVID-19 patients because of the highly-transmissible nature of the virus, the brothers say. Forsyth County, where Winston-Salem is located, was then among the handful of counties reporting the highest number of novel coronavirus cases in North Carolina. The rate leveled off, more or less, during the summer. Cases are now rising again: In the medical intensive care unit where the Vargas brothers work, most of the 32 beds for COVID-19 patients have been filled in recent weeks. Overall, the hospital has about 70 beds for COVID-19 patients; officials can increase or decrease the number of COVID-19 beds, depending on the need for them, a Wake Forest Baptist spokeswoman says.

Stressful Immigration Status

The two siblings spent their early years in a poor area in the state of

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Some Americans concerned about possible side effects of a COVID-19 vaccine: “We just don’t know enough”

“CBS This Morning” explores whether America is ready for a coronavirus vaccine in a special three-part series, Road to a Vaccine. Part two airs on Tuesday, October 27 and part three airs Wednesday, October 28 on “CBS This Morning,” 7-9 a.m. on CBS.


Two major clinical trials for coronavirus vaccines are resuming in the United States, after being paused over safety concerns. Estimates show the earliest time for an approved vaccine could be the end of November.

But a recent STAT-Harris poll showed a sharp decrease in the number of Americans who would get a vaccine right away.

CBS News senior medical correspondent Dr. Tara Narula spoke with a wide-ranging group about their thoughts on a vaccine.

Asked to rank their confidence level in a vaccine on a scale of 1 to 10, California resident Seana-Marie Sesma said 6; fellow Californian Adam Davis said 7.5; Lissi Marshall, a neuroscience college student from Philadelphia, said 7 or 8; Michigan resident Alyssa Kogut, who is diabetic, said 8; and Chad St. Clair, who is from California, said 1 or 2. 

St. Clair is adamant he will not get the vaccine, while Kogut said she definitely will. Marshall said she trusts the science but will wait a few months to get a vaccine. Sesma is still unsure due to concerns about potential side effects, and Davis is hesitant but open to it.

“If somehow, after however many months the participants of the preliminary vaccine research start to come out with any side effects … that would definitely change my mind,” Marshall told Narula. 

“I feel that, though the FDA has done the majority of good things, they have also taken products off the market that they approved at one point,” Sesma said. 

“We just don’t know enough about the vaccine yet. I’m young, I’m healthy. I exercise. And I’m low risk,” St. Clair said.

Sesma agreed with him. “We don’t know much about the vaccine or the long-term — short-term or long-term effects,” she said. 

Davis agreed he is concerned about potential risks or side effects. But Kogut said it was the “opposite” for her. 

“I know this virus, and I know what it can do to you,” she said. “I have diabetes, and my daughter has asthma. She’s only 7. So I would definitely take it to protect me and my kids.”

St. Clair said he is “on the other side.”

“I don’t want to panic. I know a lot of people who have had it and have recovered nicely, as well as our leader of our country,” he said. 

“For me, if I see people actually taking it and working, I’d be more inclined to do it,” Davis said.

Dr. Kathryn Stephenson, director of the Clinical Trials Unit of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center, participated in the early development of the Johnson & Johnson COVID-19 vaccine candidate, and is an investigator in trials of other COVID-19 vaccine candidates.

Asked how she reassures people

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Covid survivors deal with another lingering side effect: Dramatic hair loss

When Stacey Maravola’s hair started falling out in clumps two months after she tested positive for Covid-19, she was not initially concerned.

“I washed my hair one day and I’m pulling handfuls upon handfuls. And I’m like, ‘Maybe because it was up in a scrunchie,’” Maravola, 44, of Leetsdale, Pennsylvania, said.

But nearly two months later, the hair loss has not stopped. Each time Maravola, a health and lifestyle coach, shampoos her hair, fistfuls come out, getting tangled around her fingers and sticking to her legs as she showers.

“I’ve had to limit hair washes because I’m terrified,” she said. “I’m not a big emotional person, but I can tell you, this has changed me. I cry every single time I take a shower.”

Image: Stacey Maravola (Courtesy Stacey Maravola)
Image: Stacey Maravola (Courtesy Stacey Maravola)

Maravola is one of many coronavirus survivors dealing with dramatic hair loss, something that experts say is not entirely unexpected following a serious illness — but can be jarring nonetheless.

“It is upsetting, especially for those who have gone through a significant clinical course of Covid, to then experience this as well,” said Dr. Sara Hogan, a dermatologist and health sciences clinical instructor at the David Geffen School of Medicine at the University of California, Los Angeles. “But oftentimes, patients, once they have a diagnosis and they understand that typically this will get better, they feel better.”

Sudden hair loss can happen after any stressful event, including major surgery or even an emotional stressor such as starting a new job, Hogan said. The pandemic appears to have led to a large uptick in people who are seeing their hair thinning, she said: Hogan used to see an average of three to five hair loss patients a week and now sees up to seven a day.

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Why severe assaults to the body or mind sometimes trigger hair loss is not entirely understood. In the majority of these cases, the patient is diagnosed with telogen effluvium, a temporary condition in which he or she sheds many more hairs than the typical 100 or so that people lose in a day. Telogen effluvium usually begins about three to six months after the stressor has happened, and in most patients, the problem will resolve within four to six months, according to Hogan. (In rare cases, unremitting stress can lead to chronic shedding, she added.)

Researchers do not believe Covid-19 attacks the hair follicles, meaning the hair loss is the body’s reaction to the physiological and emotional stress that the disease caused, rather than a symptom of the disease itself. And many hair loss patients that Hogan and other dermatologists are currently seeing have never had the coronavirus to begin with.

“It’s just all the other tolls of the pandemic that are leading to the hair loss,” such as financial worries or grieving the death of a family member, said Dr. Lauren Kole, an assistant professor of dermatology at the University of Alabama at Birmingham School of Medicine.

Hair loss following Covid-19

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Multiple sclerosis as the flip side of immune fitness

genetics
Credit: CC0 Public Domain

About half of the people with multiple sclerosis have the HLA-DR15 gene variant. A study led by the University of Zurich has now shown how this genetic predisposition contributes to the development of the autoimmune disease multiple sclerosis in combination with environmental factors. The decisive factor is the shaping of a repertoire of immune cells which—although they are effective in fighting off pathogens such as Epstein-Barr virus—also attack brain tissue.

Multiple sclerosis is an autoimmune disease that damages the brain and the spinal cord and often severely limits a person’s quality of life. It affects about 2.5 million people worldwide, most of them young adults. The cause of the disease is a complex interaction between genetic factors and environmental influences such as smoking or infections.

Genetic variation and viruses as risk factors

For almost 50 years now, it has been known that a gene variant called HLA-DR15 is strongly associated with multiple sclerosis (MS). This gene variant is responsible for up to 60 percent of genetic risk. If carriers of this common gene (about a quarter of the healthy population is HLA-DR15 positive) are also infected with the Epstein-Barr virus and have a symptomatic course of infection called Pfeiffer’s disease (also known as glandular fever or infectious mononucleosis), the risk of MS increases 15-fold.

UZH Professor Roland Martin, Head of the Department of Neuroimmunology and MS Research at the University Hospital Zurich, says: “There are therefore clear indications that the interaction between HLA-DR15 and infectious agents such as Epstein-Barr virus is significant for the development of the disease, even though the exact mechanisms behind this have not been understood until now.”

An interdisciplinary, international study led by Martin has now shown that the immune cells of people with HLA-DR15 recognize certain microbes—such as the Epstein-Barr virus—very effectively, but that this “fitness” can also lead to an undesired immune reaction against the person’s own brain tissue.

Individual training for immune cells

The gene products of HLA-DR15 control how the adaptive immune system shapes an immune repertoire that allows the body to recognize and fight pathogens. One of the locations of HLA-DR15 molecules is on the surface of white blood cells. There, they present protein fragments from bacteria, viruses and body cells to the T lymphocytes of the immune system.

The T lymphocytes—which later control the immune response—learn to distinguish between foreign proteins and the body’s own tissue. This individual training of immune cells takes place first in the thymus and then in the blood. Since there are many more possible pathogens than T lymphocytes, each T lymphocyte must be able to respond to many different antigens and probably also many different pathogens.

Identifying the fragments presented

The researchers first investigated which fragments HLA-DR15 captured and presented to the immune cells. To do this, they used two novel antibodies that recognize the two variants of HLA-DR15 that occur in MS patients with a very high level of specificity. They found that the HLA-DR15 molecules in the thymus mainly

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Experimental coronavirus vaccines: When they will roll out, side effects and what it all means for you

CLEVELAND, Ohio — When University Hospitals needed volunteers willing to test an experimental vaccine for COVID-19, UH’s Dr. Margaret Larkins-Pettigrew signed up, and brought along her physician husband as well.

The couple learned they will undergo two injections of either the vaccine or a placebo; they won’t be told which they were given.

Over the next two years, they will undergo periodic physicals, keep track of their symptoms and turn over their medical records to trial organizers if they are hospitalized for COVID-19.

Larkins-Pettigrew said she felt an obligation, as a physician, to participate in the vaccine trial.

“This is a safe trial to be involved in,” said Larkins-Pettigrew, who is UH Edgar B. Jackson chair of Clinical Excellence & Diversity. “Science will direct us to make sure all of us are protected.”

All over the world, people like Larkins-Pettigrew are signing up to help pharmaceutical companies test prospective COVID-19 vaccines, as part of an effort to get vaccines to the public and stop the pandemic’s devastating effect.

In Ohio, Pfizer and its partner BioNTechSE, and Moderna — forerunners in the race to develop a vaccine — are conducting trials at research centers across the state to determine their safety and efficacy.

Ohio State University Wexner Medical Center is the site of a two-year, Phase 3 trial of the vaccine developed by AstraZeneca, a British-Swedish company, and the University of Oxford.

University Hospitals and the Louis Stokes Cleveland VA Medical Center are among 120 clinical investigational sites around the world that will collectively enroll up to 44,000 participants in a Phase 3 trial to test the vaccine BNT162b2, developed by Pfizer and the German company BioNTechSE.

Rapid Medical Research Inc., in Beachwood is testing the mRNA-1273 vaccine from Moderna in a two-year trial. Two sites in Cincinnati are also testing this vaccine.

How much protection will these vaccines offer? Will we need to get a coronavirus shot every year?

“These are all open questions,” said Dr. Carlos Malvestutto, assistant professor of infectious disease and co-chair of the COVID-19 Task Force, at Ohio State University Wexner Medical Center.

“The only way to answer them is through clinical trials,” Malvestutto said.

The public has questions as well, such as how these vaccines work inside the body, why some trial participants receive a placebo and how to join a trial.

Let’s get some answers.

How do these vaccines work?

All vaccines trigger the body’s immune system to mount a defense against invading illnesses. The approach taken by AstraZeneca is different from how Pfizer and Moderna are approaching the problem.

AstraZeneca’s vaccine uses a modified chimpanzee adenovirus, altered to make it harmless to humans, Malvestutto said. The adenovirus is used as a viral vector to carry a single coronavirus gene into the body. The coronavirus components of the vaccine spark an immune response against the actual coronavirus.

The vaccine does not include the whole virus and cannot cause COVID-19, Malvestutto said.

The Pfizer vaccine candidate is made up of messenger RNA coupled to a

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