What a difference a week makes! I don’t need to recap all that has transpired in recent days (and if I did, a lot has probably changed from the time I wrote this to time it was published).
We are going to get through this outbreak. And we are going to have amazing stories to share with our grandkids about the Pandemic of 2020, just like our grandparents told us about what it was like to live through a World War or the Great Depression.
We will come out stronger as a community. There is so much that we can model and teach our kids right now, so don’t miss out on the teachable moments.
While I am usually the guy who likes to talk about evidence-based medicine, I find myself in a place where not much is really known about the Novel Coronavirus (COVID-19). Being in the United States, we at least have the ability to reflect on what has happened in other parts of the world and implement best practices.
A week ago I had never heard of “social distancing,” but I was assured by a trusted colleague that we’d all know what it was within a week. I was also warned that our lives were going to change, and that change would come rapidly. Boy was she right on the mark!
So schools are closed, events and sports leagues are temporarily suspended. Many people are starting to work from home, not only because it helps reduce the spread of COVID-19 in the workplace, but also because their kids are out school.
We are not used to the sudden change, but it IS the right thing to do.
What are we supposed to do right now?
We’ve had several natural disasters in recent years and our community has proven to be very resilient. Unlike the times when we were smoked out and our schools closed, there isn’t really any place to escape this time.
So what are we supposed to do right here and right now?
We need to lay low.
Should kids go to birthday parties, play dates or attend gatherings?
The answer is no.
We need to get used to social distancing, and we need to start immediately.
Schools didn’t close in order to start Spring Break a week early. Schools closed so that it would be easier for our community to implement social distancing and allow us to all spread out.
What is social distancing?
Social distancing is a measure taken to stop or slow the spread of infectious diseases. It includes limiting large groups, closing schools, canceling events and laying low at home.
In other words, the more spread out we are, the less quickly a virus may spread.
For the COVID-19 virus, a minimum of six feet of separation is recommended if you happen to be around other people.
What does it mean to “flatten” or “bend “the curve?
What we have seen around the world is that this virus is very aggressive and easily spread. No one has a reason to believe that they have natural immunity, there is no vaccine and there is no medicine to treat it.
COVID-19 is far more contagious than influenza, and is much deadlier for our older generations. (See graph comparing fatalities of flu vs COVID-19)
If we do nothing and let this virus attack our population, it will explode exponentially. If a large percentage of our elderly and our medically fragile get sick at the same time, our health care system may be pushed beyond capacity.
We may not have enough ventilators or intensive care beds needed to save lives.
If we each do our part, lay low and practice social distancing, then we have a chance to “flatten the curve” and slow down the exponential spread of COVID-19 within our community. If we can slow down the rate of infection, then our doctors will have a chance to save more lives. (See the graph showing the 2 curves)
Does ‘flattening the curve’ mean the virus will pass right over us?
Probably not. If you look at the two curves, one shows a rapid spike over a short period of time, overwhelming our health care capacity. The second curve (the flatter one) forecasts less sick people at one time, but suggests that the virus will spread over a longer period of time and allow doctors the time and capacity to save more lives.
Will everyone get really sick?
No. The numbers from around the world suggest that 80% of those who get sick from COVID-19 will have a mild cold and then recover completely. But the other 20% might have a tougher course and need medical intervention.
What’s the deal with kids and COVID-19?
Well there is good news and bad news. For once it appears that there is a virus that does not seem to severely affect my young patients. Hurrah!
But that’s where the good news ends. All week I’ve heard, “Hey Doc, isn’t it great that your patients are going to be ok? We better shift our focus to the high risk populations.”
Not so fast! It DOES appear that children are still capable of spreading virus even if they have mild or no symptoms. Now that is something that we will need to address if we want to control the spread of this virus from getting to our higher risk populations.
It’s one thing when I see a patient with a cough and fever – it’s pretty easy to figure out they are contagious. But what about a toddler with a mild stuffy nose, well-appearing and no fever who goes around touching things and leaving behind an invisible snail trail?
He’s still cute and cuddly, but if he has COVID-19, then he could still pass it on to an unsuspecting parent or grandparent with potentially devastating consequences.
One of the reasons why schools and youth sports leagues have been shutting down, is to better control the rapid spread of this virus amongst the kids in our community.
How long are kids contagious?
We don’t really know. Last week, I was able to listen in on a conference call from the CDC. One of the presenters shared that COVID-19 has been detected in kids’ respiratory secretions for up to 22 days, and in their poop for up to 30 days!
They did qualify that no one was sure if the viral particles detected were still “contagious,” but given what we know about pediatric patients and viral “shedding,” it is very possible.
Time will tell. Wash your hands.
Asymptomatic and Pre-symptomatic carriers
An asymptomatic carrier is a person who has a viral infection, is not showing any symptoms but could still infect another person.
Kids (and others under the age of 20) are capable of being asymptomatic carriers, and it is hypothesized that some adults can be, too. While we do not know how much asymptomatic carriers may contribute to the spread of COVID-19, we must keep this in the back of our minds.
A pre-symptomatic carrier, is a person who is coming down with an illness, but has not started showing symptoms yet. It may take up to 14 days for a person exposed to COVID-19 to develop symptoms and it is possible that some people may be able to transmit the virus before they develop full symptoms.
Social distancing helps minimize asymptomatic and pre-symptomatic contagiousness and is a major reason why kids, in particular, should be laying low and not hanging out right now.
How long can the virus live on a solid surface?
In a separate CDC conference call, it was mentioned that in a controlled environment the COVID-19 virus was found to “live” on stainless steel surface for about 3 hours. When someone sneezes a big wad of mucus onto a counter top, the virus may be able to survive much longer.
I have seen multiple reports of the virus being detectable for up to nine days, but again it is not known if the virus is still capable of being transmitted just because it is detectable. We just don’t know at this point, so be vigilant with bleach and alcohol-based cleaners.
What can we do?
Take things one day at a time. Hope that if infection spreads that it spreads at a slow rate and that our doctors have the resources to care for each patient.
If that happens, then we’ve done a great job with our social distancing.
Be patient and expect change to continue. This outbreak isn’t going to pass in two weeks, so if that is your timeline, then I suggest that you reset your expectations.
Be kind. Just because we aren’t all congregating together and shaking hands doesn’t mean that we can’t be kind and empathetic to one another. Pick up a phone and call a friend.
If you can’t visit the grandparents (because they live far away or you are trying to not expose them) see if you can teach them to FaceTime with the grandkids.
Don’t hoard. Leave some basics for your neighbor. Besides, large crowds at the grocery stores is not respecting social distancing and defeats the purpose of shutting things down.
Enjoy quality time with your family. Hopefully everyone in your house is feeling well and you can spend time together. As a society we are WAY too busy and we do not make enough time for family.
Cook and eat your meals together. Get out a puzzle and some board games.
Turn off the TV. Nothing good is going to come from watching the news. It’s just going to make you more anxious. There are no sports on TV.
Turn the TV off and be present with your loved ones.
Stay off of social media. It will make you more anxious than the news.
Don’t overwhelm your doctor’s office unless you are REALLY sick. Doctors don’t currently have COVID-19 testing kits and you will not recover any faster by getting a test done.
The next few weeks are probably not the time to visit the doctor for routine well checks. As doctors’ offices are trying to minimize exposure to healthy people, you may find that doctors are more inclined to help answer questions by phone rather than in person.
Is there is role for Telemedicine?
Yes! I will be honest, a week ago I was not a huge fan of remote doctor visits via video chat.
I generally prefer to see my patients in person, but given our current situation I am very happy that we have alternative methods to communicate with our patients remotely.
I am personally looking forward to exploring telemedicine in the coming weeks so that we can minimize the number of visits in the office.
Is there any good news?
YES! We can see that the vast majority of people who catch COVID-19 will get mild cold symptoms and get better quickly. Hopefully, they’ll even develop some long-term immunity.
Hopefully, by next year we’ll have a vaccine and some medication options.
If you are forced to lay low, take advantage of having time at home with your loved ones. Pretend that you have a really big remote control with a PAUSE button. Push pause and take advantage of having a slower pace for the next few weeks.
For now, social distancing is the way that epidemiologists feel that we can best “bend or flatten the curve.”
Things will probably get worse before they get better, but if we all lay low, avoid crowds and decrease close contact with others then we have a chance to slow the spread of COVID-19 and let our white-coated superheroes come in and save the day.
Dr. Dan Brennan is a board-certified Pediatrician at Sansum Clinic, who thanks you for doing your part to help prevent the spread of COVID-19. Please contact Dr. Dan at 805.563.6211, firstname.lastname@example.org or visit www.sbpediatrics.com.