A lot has happened in the past few weeks. Lives have completely moved indoors, businesses are not only closing but going under, and the economy is shuddering. There’s palpable fear in the air around the world and as we turn our attention more than ever to devices and social media there is unfortunately a mass of misinformation out there. I’ve prepared a summary article on coronavirus that addresses all the facts and some of the myths. If you feel inclined, spread and share. 

What is Coronavirus?

Coronaviruses have been around for a while. It was first discovered in the 1960’s.  It’s something we test for in extended viral panels in a select population of patients, and something that many people, especially, children, get in the winter time. Coronaviruses are a family of viruses that have different strains, meaning they aren’t all the same. The ones we have seen year in and year out commonly cause mild symptoms that manifest as a common cold (runny nose, congestion, cough). Examples of these include strain 229E or OC43 (is your head spinning yet?!).

Other coronaviruses, such as SARS (severe acute respiratory syndrome, early 2000’s pandemic) and MERS (middle east respiratory syndrome in 2012-2013) can cause severe disease and can be deadly. Even the “mild” coronaviruses that cause the common cold in some people can make other people significantly sick (similar to RSV, or respiratory syncytial virus). 

COVID-19, or SARS-CoV-2, is similar to the SARS and MERS strains in that it has a higher rate of causing significant respiratory symptoms and potential death (numbers below). Unfortunately, there is no current vaccine against human coronaviruses and no definitive treatments (though there are some potential treatments and vaccines in the works). 

By the way, the name comes from the appearance of the virus under an electron microscope (it looks like it has a “crown” or “halo”, the Latin word for corona). 

Symptoms of Coronavirus

As stated above, the “common” coronaviruses (I.e. 229E or OC43) usually only cause cold symptoms such as runny nose (rhinorrhea as we like to call it), congestion, fever, and potentially cough. Some people are asymptomatic and have NO symptoms. In other people, however, it can cause more severe symptoms such as difficulty breathing or inability to eat/drink anything leading to dehydration. This tends to happen in kids (or adults) who have underlying chronic health issues such as asthma. 

For COVID-19, it’s much of the same with a few exceptions. Some people have NO symptoms at all. Others have mild cold symptoms. Some have flu-like symptoms with higher fevers and body aches. A personal friend of ours ONLY had body aches and tested positive for coronavirus. Other symptoms that are being reported in high numbers are gastrointestinal symptoms such as nausea, vomiting, and diarrhea. Finally, some people are reporting loss of taste and smell with or without the other symptoms above as is the case with some friends of mine in New York. 

More severe manifestations of the virus are shortness of breath and dehydration due to an inability to keep fluids down. Shortness of breath simply means trouble breathing, and if you have this symptom you should seek medical care immediately.

The take-away is that the symptoms can be diverse and MANY people will not have severe symptoms. This is why it’s important to follow public mandates to stay at home, limit social contact, and avoid crowded areas. I know you’re asking yourself- how’s it spread? Don’t worry, I talk about that below 🤧

The Numbers, Explained 

On the day before publication of this article (March 27th, 1300 EST) the CDC reported 85,356 cases of COVID-19 with a total of 1,246 deaths in the USA. This means a 1.46% case fatality rate.

In context, the CDC estimates (on the low end) there have been 38,000,000 cases of influenza this season with 24,000 deaths. This indicates a 0.06% case fatality rate- meaning coronavirus is 24x more deadly than influenza, right??

NO. It is clearly very infectious, and the numbers are staggering (especially in Italy where there is a reported 10% case fatality rate and Iran/Spain where it’s above 7%). However, it is not only very difficult to determine just how deadly a novel disease is, but it is also prone to error. Germany, for instance, is testing both critically ill patients and those with mild symptoms which is why their case fatality rate is only around 0.5%. 

So why are the numbers inflated? A few factors are at play. The first is testing bias. Healthcare systems are focused on testing people who are severely ill and are presenting to a hospital for care. These people are at higher risk of dying (given they were already sick enough to warrant going to the hospital) than people who aren’t seeking care and thus aren’t going to get tested. This automatically pushes the fatality rate higher than it will eventually be. If we were doing massive, wide-spread testing from the get-go, our numbers would be much lower.

The second factor is the capability of the healthcare system in question. In Italy, for example, there weren’t enough staff or ICU beds, (not to mention equipment like ventilators) to provide the life-saving care needed. Hence why the case-fatality rate is so bad. This sad fact is one of the entire reasons for the “flatten the curve” campaign and the graph you see below: 

The biggest key to take away is to not PANIC- the number of cases is going to rise rapidly once we start testing, and the case-fatality rate is expected to drop. Be cautious but don’t freak out! 

A final note on the numbers- we know this virus isn’t affecting kids under 18 years of age as much as older adults. That doesn’t mean they’re immune! There has been at least one reported pediatric death so it’s best to still be cautious and take the advice to socially distance yourselves. 

Misinformation on Coronavirus

There’s a great deal of misinformation out there on Facebook, instagram, and the news. In addition, a lot of bloggers are putting out information that has no scientific basis, and it’s important to get evidence-based information. As more misinformation pops up I’ll add it here. 

Ibuprofen makes the disease worse. I’ve been asked by several people about this one. There was an early report out of France that taking ibuprofen while infected with coronavirus made the disease worse. There is NOT enough data to support this! This was only an observation and not proven. Let me explain. If you look out your window in spring and it’s sunny you might come to the conclusion that it’s going to be warm or it’s going to be a gorgeous day. BUT that might not be the case! It could be cold, or the day could go south very quickly. You have to use more scientific methods (i.e. weather app on your phone, meteorologist) to determine the conditions outside. Neither the WHO nor the CDC recommends against using ibuprofen as a fever reducer or analgesic to help with the potential symptoms of aches and pains. 

All masks are important in preventing spread. You’ve likely seen people wearing masks in stores, airports, and on TV. We saw it coming back from our recent trip to San Francisco! Masks aren’t indicated in these scenarios and should only be used by people caring for (or in close proximity to) someone with COVID-19. These masks should be N95 (or N99/N100) and the wearer should be fit tested (as all healthcare providers are annually) as there are different sizes and shapes for different faces. If it doesn’t fit properly, it won’t keep the virus out effectively. These masks have specific markings on them so you know they’re official, and ONLY healthcare providers should use them (especially because there’s a shortage). These masks filter out 95% of very small (0.3 microns) particles, so basically all bacteria and viruses (including COVID-19). Fancy ones with exhalation valves don’t provide the same level of protection. 

    Surgical masks, on the other hand, don’t provide protection against small airborne viruses or bacteria. They only protect against large droplets. In addition they aren’t fitted to the face so leakage when you breathe in is bound to happen. Even if someone within 6 feet of you coughed and had coronavirus, you could be exposed. 

The best way to avoid exposure is to avoid crowded places, avoid being within 6 feet of people, and to stay home. 

For flying, most people are surprised to learn that airlines have HEPA filters that filter out 99.9% of particles and that cabin air is filtered 20-30 times per hour. 

Summary: masks have specific purposes, but they are NOT for everyday use. Wash your hands, avoid people who are sick, avoid touching your face, and cover your cough. Stay home if you’re sick and even if you’re not!

And for God’s sake, if you think wearing gloves is going to protect you but you touch food, your phone, or the card reader at the store with it and then your face you’re defeating the purpose of the gloves…. 🤦‍♂️ 

It’s spread in so many different ways it’s impossible to prevent. COVID-19 is spread primarily through people who are in close contact through respiratory droplets when someone coughs or sneezes. The general consensus is that the sicker you are, the more contagious you are. The concern with COVID-19, however, is that you can be contagious BEFORE you are symptomatic. This would still have to be through contact with secretions (kissing, saliva, nasal drainage), it doesn’t just JUMP from person to person. 

Though it can be possible to spread the disease from contaminated surfaces or objects, this isn’t the primary way it spreads and is easily mitigated by NOT TOUCHING YOUR FACE (even if you’re wearing gloves) and washing your hands frequently.

Treatment of Coronavirus 

There are many potential treatments being investigated currently for COVID-19. I won’t go into all of them, but a list is below: 

High dose Vitamin C can be useful for people who have been admitted with a blood stream infection (i.e. sepsis) but not enough is known about its benefit with severely sick people who have coronavirus. Trials are currently ongoing. There’s also no evidence that taking Vitamin C helps prevent infection with COVID-19, and while standard doses that boost immunity are harmless, overdosing is possible. 

Antiviral drugs (remdesivir, tamiflu, etc) are being studied because they have shown some benefit in the past with SARS and MERS. Early studies show that remdesivir helps stop replication of the virus in animal and laboratory studies. Large studies are underway and results are expected around April/May 2020 (source). 

Plaquenil and it’s related medication chloroquine are used in the treatment of malaria as well as inflammatory diseases such as arthritis and lupus. There is early laboratory evidence that both of these medications kill COVID-19. We should have more evidence in the next few months, but most people don’t need this medication as they aren’t seriously ill and hospitals are starting to limit it’s use. It also has side effects and shouldn’t be taken unless you are under the supervision of a healthcare provider. 

Proven treatment: Supportive care. Viruses don’t improve with antibiotics and your body has to get rid of the virus over time. All we can do as healthcare providers is support you through the illness. What this means is helping you manage the symptoms. For example, if you feel short of breath, we can help you breathe easier using oxygen or breathe for you using a ventilator. (Interesting note, Dyson, the vacuum guy, is making 15,000 ventilators to help with the potential shortage!!). When your lungs start improving, we will peel back any breathing support you may need until you can breathe on your own. 

In addition, it may mean giving you fluids intravenously if you are too weak to drink or can’t drink because you are having a hard time breathing. Once you are able to drink fluids, we can stop the IV. 

Other supportive measures include close monitoring of your vital signs if you are admitted to make sure your body is coping with the illness enough. For most people, supportive care means staying at home drinking plenty of fluids, taking Tylenol/Motrin as needed for fevers or aches/pains, and resting.

Treatment of interest: 

Monolaurin is a compound that comes from coconut oil and is thought to be similar to some fats in breast milk. If you consume coconut products, your body is converting some of it into monolaurin! You can also purchase monolaurin as a supplement. 

So what about monolaurin? A study done back in 1982 by a virologist named John Hierholzer working at the Center for Disease Control showed that monolaurin was virucidal, or killed the virus, by disintegrating the “shell” around the virus. 

Does this mean it works for COVID-19? Absolutely not, but it could be. Not much is known or established about the side effects, interactions, or dosing of the medication but it could help prevent or treat COVID-19. While more information is needed, there are supplements available on the market. You should discuss this supplement with your healthcare provider BEFORE starting to take it to ensure it’s safe. 

Anxiety and Coronavirus: How do my kids and I cope?

Obviously this is a stressful time for everyone, adults and kids alike. One of the first keys is identifying stress and anxiety in yourself and your children. 

Kids display a variety of symptoms when it comes to anxiety, and they can be hard to identify. Symptoms can include abdominal pain, hyperactivity, or acting withdrawn. Keep an eye out for these types of symptoms in your younger kids. It’s also important to talk to the older kids about how they’re coping with the current conditions. 

For activities, your kids can stay connected to others through supervised FaceTime or phone calls with friends. I would also recommend using this quarantine time as a means to have one on one time. These activities can help you feel connected to the world even when we’re trapped in our houses. 

Finding ways to relax can be done as a family as well. Yoga can be incredibly relaxing and there tons of free resources. YouTube has an entire list of free yoga videos and Do Yoga With Me is offering 2 months free due to current conditions. Apps like Yoga Studio and Peloton also have free trials. 

Meditation is something my wife and I love, and she uses the Headspace app regularly. Calm is another one. We’re also avid Peloton lovers and the Peloton app has tons of meditations (some just 5 minutes). 

Controlled breathing is another technique that can help. Breathing in for 5 seconds, holding for 5 seconds, breathing out for 5 seconds, and then holding for 5 seconds before breathing in again for a couple of minutes (square breathing) can be very calming. 5 count breathing has also shown to be useful for kids. They can even help you count at the very least.

Finally, do things you love. Read a good book. Cook a new dish. Watch a funny show as a family. Exercise. Camp out in your house or your yard. Play card games or other board games. Take a walk with the dog. There are a ton of ideas out there! 

Resources

In the current times it’s hard to get by, especially when stores are closed and inventory is low. Below, find links to education and websites that are selling key items like baby wipes, diapers, and formula. If you have another resource to share, please comment! 

Education:

CDC Website

American Academy of Pediatrics

Diapers, wipes, formula, and other essentials: 

Obviously shipping anything at this time is difficult and delivery times may vary, but the following websites (as of the time of publishing this article) have diapers, wipes, and formula in stock with free shipping. Amazon has products too but they are having significant delays in delivering items due to current conditions. 

Bye Bye Baby (free shipping over $50 purchase)

Costco (with membership)

Honest Company (offers subscription for diapers/wipes, free shipping, obviously more expensive than regular brand items) 

Quill

Jet

____________________________

FINAL NOTE: 

Please don’t forget to support your local businesses that are suffering. Buy take out, order online, and give good tips when able. Let’s come together as a community and get through this together! 

Any other questions? Ask them below 👇

Make sure to follow ThePedsMD for more evidenced based information and check out our instagram @thepedsmd ✌🏼

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