Coronavirus 2020

As of:  November 1, 2020

In this emergency situation, my staff and I are working hard to keep you, and us, safe and cared for.  I won’t repeat everything you’re reading in the news.  But here’s my take, and our response.

 

How much has Coronavirus spread?

In Delaware, case numbers have started to increase again recently, in step with the rest of our region.  The rate of new cases in Sussex County is 50% to 100% higher than in New Castle or Kent, especially among non-white populations, according to State data.  Less than 3% of Delawareans have tested positive since March.  So even if many cases have gone undetected, this still means that almost all of us are still susceptible.

https://myhealthycommunity.dhss.delaware.gov/locations/state/days_to_show/90/primary_trend_type/bar#trends_dashboard

During this entire epidemic, perhaps only a few dozen children in our practice have tested positive for COVID-19. In almost all cases, the family has known exactly who they caught it from, and the nature of the direct exposure.  Generally, the exposure is indoors, and prolonged.  We have not yet seen kids become infected from casual exposure, in parks, stores, or even day care.  Other pediatricians in our area report similar experiences.  (This may change as more kids return to school and day care.)

This means that, in our community, we seem to be doing a good job so far of protecting each other, with masks, hand washing, and social distancing.  These protective measures clearly help us protect ourselves, and protect each other.

But epidemiologists believe that over 80% of our American population is still susceptible.  The CDC reported in September that less than 10% of Americans have positive antibodies on a blood test.  Even now, 8 months in, we have a long way to go before we see protection from “herd immunity.”

Eventually, I expect over the next couple of years that most of the population will contract the virus and develop immunity (or eventually get a vaccine), just as most of us have had “mono” and other childhood illnesses. But kids will not be vaccinated for quite a while, because the vaccines under development are being tested only in adults so far.

However, we’re seeing kids with ordinary illnesses every day!  Even though everyone is trying to isolate, kids are still getting ordinary respiratory and intestinal viruses (though less frequently than usual).  Most of our patients with fever still have an illness other than Coronavirus.  (So please get your flu shots!)

 

How is it transmitted?

Most epidemiologic evidence is still that most people contract COVID-19 from a direct, indoor, person-to-person exposure with a sick contact.  There probably is also some spread from asymptomatic (or “pre-symptomatic”) people, but even then, the exposure is generally an in-person, close personal contact from relatively heavy “respiratory droplets” that rarely travel more than 6 feet.  This is why mandating masks and social distancing, even among friends and family, has been so effective in controlling the spread of disease.

There has been much scientific debate about “aerosol” transmission of COVID-19 by smaller, lighter particles.  The CDC is now acknowledging that it is possible, generally in closed spaces with poor ventilation.  The evidence for this continues to be mostly theoretical, tracking RNA “signatures” rather than documented illness; there are very few reported cases of transmission of actual illness from small droplets, hanging in the air long after a contagious person has left the room.  Wearing masks greatly reduces infection rates.

It is also theoretically possible to pick up the virus RNA from “fomites:” objects in public places such as door handles, that contagious people might have left their handprints on.  Again, there are very few if any cases of documented transmission of COVID-19 this way.  It’s easy and reasonable to use hand sanitizer when you leave a store or gas station (and don’t touch your face while you’re there!).  And you should wash your hands when you return home.  But I really hope people will soon stop disinfecting their groceries and putting their mail in quarantine.

 

How do I know if my child has Coronavirus?

We can arrange for any patient to be tested for COVID-19, regardless of symptoms, if the family is concerned.  I am generally not encouraging patients without a known exposure to get tested unless they have significant symptoms:

  • Fever (not just low grade) for a couple of days,

    Looking unusually ill (more than expected from a usual viral fever).

  • Direct, personal exposure to a person who is test-positive for COVID-19.

Profuse runny nose is not typical of COVID-19 symptoms.  Most of my patients with fever and cough have had flu, strep, ear infections, or another upper respiratory illness. In our practice, we have still not seen any patients with the Kawasaki-like “multi-system inflammatory syndrome” that’s been reported in children, although there have been a few reported at DuPont Hospital.

 

What testing is available?

PCR testing is available, if symptoms warrant and with an order from us.  Christiana Hospital can perform testing at their facility.  The patient must make an appointment, and bring our signed order for the test.  Also, without a doctor’s order, anyone can get a free test through the State of Delaware; see our website DMPKids.com for details.  Medical Aid Units are doing testing with various technologies; they may charge for the service.

Antibody tests on a blood sample can be drawn at a commercial lab such as Quest or Labcorp.  A positive test implies a prior infection, at least 2 weeks ago.  The antibody test may turn negative 2-3 months after a documented infection, unlike tests for most viral infections such as Chicken Pox.   I have not generally been ordering COVID-19 antibody tests for patients.

Rapid antigen tests, which give results in less than an hour, have been developed.  We are hoping to have such tests in our office soon.  They are less sensitive than PCR tests, and the CDC recommends that a negative rapid-antigen test should be followed with a PCR test if there is a reasonable suspicion of exposure or illness.

False-negative tests do occur.  If you are exposed to a known case of COVID-19, you must still quarantine for 14 days from the exposure, even if your test is negative.

 

Isn’t this all just “media hype”?

 

You bet – and a darned good thing, too!  In an epidemic of a serious disease, we must count on responsible newspapers and other traditional news outlets to alert the public, to keep each other safe.  Journalists are reporting verified facts, as accurately as possible.

And the facts are concerning.  Infection rates in the USA are far higher than other developed countries; and our numbers are rising as other developed countries are controlling the virus.

However, many hoaxes are being spread on the internet, designed to confuse our trust in scientific reports about the spread and danger of COVID-19. 

  • It is not true that hospitals are paid to over-diagnose COVID-19.

  • It is not true that falsely positive reports are being generated on people who never were tested.

  • Wearing a proper mask is not dangerous for any person, regardless of their age or health, and does not make you sicker.

  • The virus’s existence, or its reported spread or lethality, is not a hoax being spread for political purposes.

  • The virus did not stem from a military operation in the U.S., China, or any other country’s labs, accidentally or intentionally.

  • Coronavirus is not going away, or becoming less serious or less lethal.Case numbers are rising, not falling.We are, unfortunately, very far from “rounding the corner.”

Please stay informed by getting your news from reputable newspapers and TV.  Try to distinguish between fact and opinion.  Be wary of home remedies and conspiracy theories.  Do NOT rely on Facebook!  If what you read sounds crazy, it’s probably wrong.

 

What about masks?

Who?  Everybody should wear a mask if they can, no matter the age.  Even young children can wear a mask, if they will cooperate with wearing it.  Even toddlers can wear masks safely, and learn to cooperate.  Wearing a mask is not dangerous, does not cause breathing problems (though nobody enjoys them), and does not make Coronavirus somehow worse.

What kind?  Anything that fits tightly, and keeps air from escaping out the sides.  The mask must cover the nose, as well as the mouth.  Don’t use masks with valves that allow easy air escape; they won’t protect people around you.  Beards make masks less effective (sorry, fellows) because the mask can’t fit tightly.  “Gaiters” seem to work fine, if they prevent air escape and have at least two layers.

What material?  Cloth masks are fine for general public use, if the material is a tight weave; double or even triple layers work much better.

Masks with gaskets or pop-off valves are NOT suitable and should not be used in public.  They protect the wearer, but because exhaled air is not filtered through the valve, they do not protect the people around you.  Please wear masks without a gasket, unless it has a separate filter.

In our office, we want to protect you, and protect ourselves.  So our staff uses only N-95 masks (or similar) while seeing patients.

Remember that masks are not just to protect you from contagion, but also to protect others from catching something from you!  Wearing a mask is a public courtesy, even if you don’t feel sick yourself.

 

When is the COVID-19 vaccine coming?  When will “this” be over?

We all hope that widespread use of an effective vaccine will cause “herd immunity” to protect us all.  News reports encourage us that a vaccine may be available “soon.”  Several technologies are being tested; one or more may be available by early 2021.

But the release of the first vaccine is only “the beginning, not the end.”  Different vaccine technologies may work better than others; or may cause side effects that weren’t recognized during their initial testing.  There may also be delays in manufacture, delivery, and administration. 

Once the first vaccine is available, hundreds of millions of doses need to be distributed fairly and administered safely; this big project won’t be finished in a couple of months.  Kids won’t be vaccinated at all, until separate testing is done in children.  And people need to be reassured that the vaccine, having been developed this quickly, is indeed safe and effective.

I expect that we will all be wearing masks for quite a while, well after next summer.

 

What should I tell my child?

Kids may pick up on everybody’s anxiety.  Emphasize that your family has control over your risk, and that hygiene (including universal masks) and social distancing is effective.

It can be helpful to review as a family the positive actions you’re taking, to give everybody a sense of control.  Be a role model:  “Here are the actions we’re all taking to stay safe!”

Reassure kids that children are unlikely to suffer major complications.  But also point out that kids have a responsibility to protect the people they love around them, just as the adults do, by avoiding unnecessary contact and practicing good hygiene.  Kids under 12 seem less likely to catch COVID-19, but they can get it, and they can become quite sick; they have a responsibility to take precautions.  Teens are just as likely as adults to catch and be contagious for COVID-19; it’s dismaying to see teens in public not wearing masks or social-distancing.

Teach the kids good handwashing and sanitizer use.  Practice with them, and teach by example.  Have them search for lots of good kids’ videos that demonstrate hand washing or sanitizing.  (And let me know if they find good ones – I’ll publish them!)

 

What about school this fall?

To be honest, I don’t know how to advise patients about restarting school in person, or sports.  We all regret the lost season of school last spring; teachers were caught by surprise, without a plan or even teaching materials.  But this year, parents must weigh the risks.

Elementary grades will be a struggle to teach remotely.  But these younger kids are less likely to cooperate with masks and social distancing in a school environment, as the weeks wear on.

Kids with learning issues or behavior issues will be more likely to need an in-school environment.  Some kids will thrive in the short term with more limited social contact, but others need to be with their peers.

I do not recommend that kids with common medical conditions, such as controlled asthma or recurrent allergies, be specially restricted from an in-school environment. 

Ultimately, every parent will need to evaluate each situation, child by child, classroom by classroom.  In general, as is so often true, kids who already have good academic and social skills, with more family support and financial resources, will have an easier time, regardless if their education is “remote” or in-school.

In the meantime, every kid in school who gets the slightest symptoms will be sent to the doctor to verify that they don’t have COVID-19.  So minimize the chances of being sent home:  be sure that your whole family gets flu shots this fall!

 

What to do with schoolkids at home?

  • Encourage the kids to play outside, even if the weather is bad.Make sure everybody gets regular exercise!

  • Make sure everybody goes to bed on time.Try setting a bedtime alarm, especially for teens.Sleep deprivation will cause behavior problems, and it may also hinder their immune system.

  • Make plans to fight social isolation every day and every week.The whole family can talk to friends or older relatives using FaceTime, Zoom or Skype, or just a phone call (good for both of them!)

  • Schedule a time every day to do an activity with your kids (not watching TV).The kids will look forward to it, if they know what time they’ll have your undivided attention.Try making “family game time” part of your daily schedule.

  • It’s more important than ever to limit recreational screen time.Passive screen time such as watching shows, video games and social media should still be limited to 1 or 2 hours per day.But note that schoolwork on the computer is “free.”So is social time, talking with family and friends by video chat, or even by text; kids can talk with their friends and family as much as they want.

 

What is Delaware Modern Pediatrics doing?

  • We are continuing to provide all routine sick and well care.We have not restricted our hours, since the beginning of the Pandemic.

  • Our office has dedicated Sick and Well waiting rooms; please make use of them!Chairs are placed a “socially distanced” 6 feet apart. All visitors, including accompanying parents and family, must have their temperature measured on arrival.All patients are taken back to an isolated exam room as soon as they are checked in.

  • We have sequestered all our toys (so bring your own). We are diligently disinfecting exam rooms and surfaces between patients.

  • Our staff is wearing protective equipment for all patient encounters.We’re checking our own temperatures every day, and sick staff members are sent home immediately (with sick pay).None of our staff has yet been infected with Coronavirus.

  • If there is a reasonable (even if low) suspicion that your child might have a mild case of COVID-19, we may arrange to bring you in at the end of the day.

  • In certain circumstances, we may make use of Telemedicine encounters.

 

How can parents help us?

  • If your child is sick, please call our office first – NOT Urgent Care or the Emergency Room.Usually we can schedule an appointment the same day, if you call us in the morning. Go to the ER only if you think your child is so sick that they may require hospitalization.

  • If your child has asthma, please continue giving the “controller” medication (Flovent, etc.) that has been prescribed, even if they’ve had no asthma symptoms for months.If they have ADHD, please continue to give their usual daily medications, even while not in school.If you need refills, please call.

  • If you have an appointment with us but can’t make it, PLEASE call to reschedule as soon as you know!No-shows make it harder for us to care for everybody.

  • If you’re coming for a routine checkup, but the child has any fever or upper respiratory symptoms, please come to the Sick waiting room, not the Well side – and call us first to let us know.

  • Please do NOT avoid coming to our office for regular care!  We are taking all precautions to keep your family (and ourselves) safe.  You are much safer in our office than, say, in the grocery store.   But deferring infant vaccines simply puts them at risk for epidemics of measles, meningitis and pneumonia.

 

What if I have more questions?

Call us!  We’re working hard, and we’re ready to help you.  Thanks for your confidence in us.