Coronavirus 2020

As of:  August 24, 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.

(If you'd like this information as a PDF handout, scroll to the bottom and click the link.)

(For information on free COVID-19 testing, click here: http://www.dmpkids.com/index.cfm?fuseaction=content.pageDetails&id=212821&typeID=63

 

How much has Coronavirus spread?

In Delaware, case numbers have started to increase again recently.  Much of the new spread is in Sussex County, where the rate of new cases is about twice the rate in New Castle County or Kent County.

During this entire epidemic, perhaps only a dozen children in our practice have tested positive for COVID-19. In each case, the family has known exactly who they caught it from, and the nature of the exposure.  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 kids return to school and day care in larger numbers.)

This means that, in our community, we seem to be doing a good job so far of protecting each other, with masks, hand washing etc. 

But epidemiologists believe that perhaps 80% of our population is still susceptible.  Even now, 6 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 when it’s developed), just as most of us have had “mono” and other childhood illnesses.

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.  Most of our patients with fever still have an illness other than Coronavirus.

 

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 so, the exposure is 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 evidence for this is theoretical, mostly tracking RNA signatures; there are very few reported cases of transmission of actual illness from small droplets, hanging in the air after a contagious person has left the room.

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?

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 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.

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.

 

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, testing is available through the State of Delaware; see our website for details.  The sample for a PCR test is an anterior nasal swab, not as unpleasant as the flu test.  Results will be reported several days later.

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.  I have not generally been ordering antibody tests for patients.

Rapid antigen tests, which give results in less than an hour, have been developed.  But they are hard to find, and the CDC is not yet convinced that they are accurate enough for general use.  I am not aware of any facility in our area that does them.  But we are investigating the possibility that we could have rapid antigen tests available in our office in time for the fall season.

 

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 overdiagnose 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.

  • The virus’s existence, or it’s reported spread or lethality, is not a hoax being promulgated 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.

Please stay informed by getting your news from reputable newspapers and TV.  Try to distinguish between fact and opinion.  Do NOT rely on Facebook!  Be wary of home remedies and conspiracy theories.  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 (though they don’t like it!).

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. 

Many commercial masks are made in China, and standards vary.  Even masks marked “KN-95” (supposedly the Chinese equivalent of the N-95 standard) may not offer as much protection as promised.  The FDA has banned many Chinese manufacturers from importing “KN-95” masks until their efficacy can be tested in the US, since many Chinese masks have failed FDA testing.  (I believe that this situation has improved since May, when it was initially reported.)

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 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.  Remember that once it’s available, hundreds of millions of doses of medical vaccine need to be distributed fairly and administered safely; and the it won’t be finished in a couple of months.  And people need to be reassured that the vaccine, having been developed this quickly, is indeed safe and effective.

I will not be surprised if our lives continue the way they are, into 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 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, and even young healthy parents, 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.

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.  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 generally 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.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 screen time.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.But passive screen time such as watching shows, video games and social media should still be limited to 1 or 2 hours per day.

 

What is Delaware Modern Pediatrics doing?

  • We are continuing to provide all routine sick and well care.We have not restricted our hours.Well children are generally seen in the morning.

  • 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, are having 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 our toys. We are diligently disinfecting exam rooms and surfaces between patients.

  • Our staff is wearing protective equipment for all patient encounters, following all recommendations from experts.Don’t be alarmed – we’re not sick!We’re checking our own temperatures every day, and sick staff members are sent home immediately (with sick pay).

  • 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 start NOW 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.  Don’t think this can’t happen – an outbreak of mumps arose at a local high school this spring.

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.

signature md.jpg

Dr. Epstein

 

(If you'd like everything as a single PDF handout, please right-click and save the link below.)