24 Mar Navigating Pandemic: COVID-19
As I study this virus, I can only hope people are grasping the seriousness of what is happening. This novel coronavirus, first identified in China and initially termed the Wuhan flu, is now infecting people throughout Tennessee with the known number of cases likely being a fraction of the total cases due to the inability to properly test.
As you read this, the cases have multiplied partly due to greater abilities to test, the results of tests just coming in, and because social distancing recommendations were made a week ago and shelter in place is just beginning. Statistics show approximately a 10-14 day lag from the time a change in social interactions is made to the point we see an impact. Hopefully, we will see some good news at the end of this week–about two weeks after the Governor recommended social distancing and avoiding group gatherings over 50 people. However, it is more likely there won’t be a lot of good news for a couple of weeks as people return to the area from Spring Break. During these two weeks, we will likely hear numbers go up, hear about sick neighbors, friends, family, and may even know our first casualty.
Why is this thing so hard to contain?
- This virus has been very hard to identify. Testing has largely been limited to those who have moderate to severe symptoms. Both a lack of test kits and personal protective equipment (PPE) available for medical professionals have restricted the ability to test everyone who could have COVID-19. Eighty percent of people are infected will have mild symptoms, and some with be without symptoms at all. For up to two weeks, a person having mild to no symptoms is shedding virus and sharing with other social contacts. In those with symptoms the virus typically doesn’t manifest for anywhere from 2-11 days with the average onset of symptoms being around 5 days from when it is picked up.
- Most of the viral shedding is in the 24-48 hours prior to manifesting symptoms.
- While the virus is droplet spread, as opposed to airborne like the flu or measles, viral particles known as “fomites” can stay on cardboard for hours and on plastics for 2-3 days. The transmission of these fomites from a person who unknowingly is shedding viral particles transmitted by his or her hand makes every shared surface (e.g. gas pump, door handle, credit card machine, grocery bag) a potential source of contagion.
- Without any innate immunity and the characteristics of the way this virus spreads, we as humans are the perfect host to continue to spread it.
Unfortunately, some have tried to go about life as usual. Whether it is a partial belief COVID-19 is a hoax or a belief that due to age, sex, or even fatalistic beliefs that it is better to get it and get over it, some are acting without any prudence and are likely becoming a part of the spread. While statistics continue to show that most who get COVID-19 will do fine–kids do remarkably well–there are those who won’t be fine. The mortality rate is much higher in the elderly than the young.
Even if we assume the percent of those who die from COVID-19 is as low as 1%, those are not percentages that we want to gamble on when we are talking about the friends and family that we love. If we want to minimize the mortality rate, we must do our part not to overload our local medical capacity.
Our major challenge right now in fighting COVID-19 and minimizing the number who will die from it is a true lack of medical supplies and hospital bed capacity. In addition to having transferred our medical systems from hospital-based to outpatient care, we also purchase most of our medical supplies from China. In the past 3 months, China has both increased their need for the medical supplies they produce and as well as, decreased production of those same supplies as factories have shut down due to COVID-19. The rest of the world has had to look to other sources for supplies. The lack of those here in Tennessee and around the United States is REAL. Medical practitioners are having to ration the few supplies we have. This is a great opportunity for us to show love and generosity to our neighbors by donating these types of supplies to medical offices if you have the resources. Our health system is in a unique situation. As healthcare providers are sidelined from illness, their ability to care for others goes down and the fatality rate goes up. Can you imagine our military infantry being asked to defend our nation against a ground attack but they are told not everyone will be issued body armor? This is the plight of today’s healthcare workers in some parts of the United States.
You Can Help!
While much of this information is grim, it is truly amazing how simple steps we each can do will help us overcome this pandemic. Action will limit both the contagion and the fear this virus is having in our community. Practice social distancing and minimize contact with others. The less touch you have with others, the less likely you are to be a part of the problem.
- Practice engaging with friends, family, and neighbors via digital platforms to stay connected and make sure everyone is taken care of. People are anxious right now–connecting and remembering hard times we have overcome will be good for the mind and soul. At the same time, if we could truly eliminate people’s physical contact with each other for two weeks we would eliminate the community spread of the virus. Then, we would be able to simply focus our efforts on those in the hospital and the consequential percent of health care workers who will require assistance as a direct result of taking care of the community spread.
- Wash hands with soap and water for at least 20 seconds or use hand sanitizer where soap and water are not available. The virus is an RNA strand inside a lipid envelope. Lipids, also known as fats, dissolve in soap and water, alcohol, and a variety of other household cleaning solutions. This is why using disinfectants and wiping down shared surfaces including boxed/bagged grocery goods and other packages that come from a delivery service. You don’t know who touched the package in the past day or two so take the extra precaution so you don’t accidentally pick up viral fomites spread from others.
- Avoid touching your face. Studies indicate the average person touches his/her face 20 times/hour.
- Cover your cough. If you are coughing, wear a face mask, scarf or bandana over your mouth in public. Otherwise, using a face mask is a waste and simply stealing it from someone who needs it (e.g. health care worker).
- Finally, stay at home if you can.
We will be here for you. We will continue to monitor and follow recommendations and guidance in the care of our patients from the American Academy of Pediatrics (AAP). The AAP recommends keeping up to date with your well-child checks. For practices that are able, they recommend separating well visits from sick visits, and isolating patients in exam rooms as they arrive. We are grateful that our clinic allows us to do just that.
Telemedicine is Here!
Additionally, we’re excited insurance hurdles have been removed from telemedicine! As the first pediatric practice in Sumner County to implement telemedicine, we will encourage as many visits as reasonable using this technology. Not only are we screening all visits to decrease the risk of contagion from COVID-19 to our patients and staff, we are also enforcing an initial telemedicine visit evaluation for any patient who has symptoms that might be related to COVID-19. Lastly, we are using telemedicine for ADHD, anxiety, depression, rashes, and pinkeye, among other visits.
We understand this is an unusual time and want to do our best to keep our patients healthy and minimize their risk of infection by ending up in the ER, hospital, or even after-hours urgent care clinics. Through heightened awareness, infection control, communication, and technology, we can provide for your child’s care needs while protecting both you and your children throughout the duration of this pandemic.
Scott Huitink, MD FAAP
Dr. Scott Huitink loves being a Pediatrician and strives to support parents in the care of their children by encouraging, educating, and providing them with up-to-date medical expertise. His passion to provide high quality, personable, pediatric care can be seen in his face-to-face visits with children, his insights provided through his Facebook Page–“Compass Peds”, and his interest in improving the well-being of the community around him. Dr. Huitink has a wide array of experience in the care of children from newborns to young adults and has been instrumental in the education and implementation of clinical standards. He is Board Certified in Pediatrics and is a member of the American Academy of Pediatrics and can be found seeing patients in the Nashville area at Compass Pediatrics.