Are Kids Dying With COVID-19?

How many children have died with COVID-19?

Breaking News – There has been a big jump in pediatric COVID deaths in the past few weeks. (see below)

You have likely heard that COVID-19 is not supposed to make children sick, so what’s with the reports that kids are dying with COVID-19?

“Whereas most COVID-19 cases in children are not severe, serious COVID-19 illness resulting in hospitalization still occurs in this age group.”

Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020

So far, while only about 13% of cases in the United States have occurred in children and teens who are less than 18 years old, many of those “pediatric COVID-19 cases were hospitalized.”

The American Academy of Pediatrics reports at least 460 child deaths from COVID-19.
The American Academy of Pediatrics reports at least 460 child deaths from COVID-19.

Some were even admitted to the ICU and tragically, some have died.

Are Kids Dying With COVID-19?

How many kids?

So far, as of early-September, there have nearly 4,666,000 COVID-19 deaths worldwide (all ages), including over 663,000 deaths in the United States (all ages).

And some of those deaths have been in children.

It’s important to note that some these recent COVID-19 deaths in children are still being investigated, but according to reports they include:

The latest reports of COVID-19 deaths, during the Delta surge, include:

Experts have still not confirmed that COVID-19 caused all of these deaths.

Kids are dying with COVID-19.
Kids are dying with COVID-19.

Still, the AAP reports that there have been at least 460 COVID-19 deaths in children in the United States and cases are on the rise in many areas.

While there are far fewer COVID-19 deaths in children than in adults, since fewer kids are reportedly getting infected, the number of deaths is very concerning.

“Among the 121 decedents, 30 (25%) were previously healthy (no reported underlying medical condition), 91 (75%) had at least one underlying medical condition, and 54 (45%) had two or more underlying medical conditions.”

SARS-CoV-2–Associated Deaths Among Persons Aged <21 Years — United States, February 12–July 31, 2020

And that’s why it is important to continue to encourage your kids to get vaccinated if they are eligible, wear a mask, and follow all social distancing recommendations.

The latest report from the CDC lists at least 543 pediatric COVID-19 deaths.
The latest report from the CDC lists at least 543 pediatric COVID-19 deaths.

Keep in mind that there have been an additional 37 41 deaths in children from multisystem inflammatory syndrome in children (MIS-C), which is associated with COVID-19.

How Many Kids Have Died With Covid-19?

So just how many kids have died with COVID-19?

We still don’t have exact numbers, but it is easy to see that well over 200 nearly 300 children over 400 500 children have died with COVID-19.

More on COVID-19 Deaths

The Latest on Masks to Keep Kids From Getting COVID

Face masks work to prevent the transmission of COVID and can help keep kids, many of whom are too young to be vaccinated, from getting COVID.

That kids wearing face masks to keep them from getting COVID is controversial is amazing to many people, especially pediatricians.

Why wouldn’t you want your kids to wear a mask if it could protect them?

The Latest on Masks to Keep Kids From Getting COVID

And yes, the data does show that wearing a mask is safe and protects kids from getting COVID…

Need some proof?

Let’s take a look at what’s happening in Texas.

A few weeks ago, there were 86 active staff and 708 active student cases in GISD.
A few weeks ago, there were 86 active staff and 708 active student cases in GISD.

In one north Texas school district that opened early, on August 2, they now have 67 active staff cases and 564 active student cases.

While that’s a lot, it is important to keep in mind that as cases are continuing to rise in most other school districts, leading to more than a few temporary school closures, they are actually dropping in GISD!

Why?

Staff and students in GISD are wearing masks and their active case counts are dropping!
Staff and students in GISD are wearing masks and their active case counts are dropping! They also limit the capacity for indoor and outdoor events once positivity rates get too high.

It is almost certainly because their staff and students are wearing masks!

Masks Save Lives

Wearing a mask can protect the person wearing the mask and the people around them.

Need more proof that masks work?

Wearing a mask is especially important to protect those who are too young to get vaccinated and those who have a true medical contraindication to getting vaccinated against COVID.

“When used in conjunction with widespread testing, contact tracing, quarantining of anyone that may be infected, hand washing, and physical distancing, face masks are a valuable tool to reduce community transmission.”

An evidence review of face masks against COVID-19

Wearing a mask is also important as COVID variants surge, some of which are more infectious, even to those who are fully vaccinated.

Masks save lives.

“Without interventions in place, the vast majority of susceptible students will become infected through the semester.”

COVID-19 Projections for K12 Schools in Fall 2021: Significant Transmission without Interventions

Parents should ignore the misinformation and disinformation about facemasks and COVID-19.

“To maximize protection from the Delta variant and prevent possibly spreading it to others, fully vaccinated people should wear a mask indoors in public if you are in an area of substantial or high transmission.”

Use Masks to Slow the Spread of COVID-19

In addition to social distancing, they should wear a mask and should encourage their kids who are at least two years old to wear masks in school and when in public around a lot of other people.

More on Masks Save Lives

Treating Kids with COVID Monoclonal Antibodies

While anti-SARS-CoV-2 monoclonal antibodies have an EUA for older, high risk children with COVID, they are not routinely recommended by most experts.

While you are likely used to hearing that there are no real cures or treatments for COVID, a few treatments do have emergency use authorization, including monoclonal antibody therapy.

“Monoclonal antibodies that target the spike protein have been shown to have a clinical benefit in treating SARS-CoV-2 infection. Preliminary data suggest that monoclonal antibodies may play a role in preventing SARS-CoV-2 infection in household contacts of infected patients and during skilled nursing and assisted living facility outbreaks.”

Anti-SARS-CoV-2 Monoclonal Antibodies

And they are available for use in kids who are at least 12 years old!

Treating Kids with COVID Monoclonal Antibodies

So why doesn’t everyone with COVID get treated with these monoclonal antibodies?

“Three anti-SARS-CoV-2 monoclonal antibody products currently have Emergency Use Authorizations (EUAs) from the Food and Drug Administration (FDA) for the treatment of mild to moderate COVID-19 in nonhospitalized patients with laboratory-confirmed SARS-CoV-2 infection who are at high risk for progressing to severe disease and/or hospitalization.”

Anti-SARS-CoV-2 Monoclonal Antibodies

In general, they are mainly used in those older children (at least 12 years of age) and adults who are at high risk for severe disease.

“When using monoclonal antibodies, treatment should be started as soon as possible after the patient receives a positive result on a SARS-CoV-2 antigen or nucleic acid amplification test (NAAT) and within 10 days of symptom onset.”

Anti-SARS-CoV-2 Monoclonal Antibodies

Also, ideally, treatment with monoclonal antibodies should be started very early, but even more importantly, it involves an IV infusion. So it is not something that your pediatrician will likely be able to give your child in their office.

So where can you get these monoclonal antibodies?

Monoclonal antibody therapeutic treatments have been distributed to hospitals and infusion centers around the country. You can hopefully find a treatment location nearby if you need to get your high risk child treated.

How do you know if your child is high risk?

People aged 12 or older may be considered at high risk for developing more serious symptoms—making them eligible for mAb treatment—depending on their health history and how long they’ve had symptoms of COVID-19.
People aged 12 or older may be considered at high risk for developing more serious symptoms—making them eligible for mAb treatment—depending on their health history and how long they’ve had symptoms of COVID-19.

Does your child who is at least 12 years old have chronic kidney disease, diabetes, heart problems, chronic lung disease, including moderate to severe asthma and cystic fibrosis, etc., sickle cell disease, a neurodevelopmental disorder, including cerebral palsy, or have a medical device (tracheostomy, gastrostomy, or positive pressure ventilation, etc.)? Are they immunosuppressed? Are they overweight, with a BMI above the 85th percentile for their age?

Talk to your pediatrician if you aren’t sure if your child is high risk and if you need help finding COVID monoclonal antibodies for your child.

Treating Kids with COVID Monoclonal Antibodies?

You may also want to ask if getting your child treated with monoclonal antibodies is something you really should do…

“Currently, there is insufficient evidence for utility, safety, or efficacy to recommend the routine use of monoclonal antibody therapy for children and adolescents with COVID-19, even those considered to be at higher risk of hospitalization or severe disease. At this time, neither bamlanivimab nor casirivimab plus imdevimab should be considered standard of care in any pediatric population, even in patients who meet high-risk criteria. There are no data supporting safety and efficacy in children or adolescents, and the evidence supporting use in the adult population (including young adults) is modest and/or unpublished and has limited applicability to pediatrics or to many specified risk groups.”

Initial Guidance on Use of Monoclonal Antibody Therapy for Treatment of Coronavirus Disease 2019 in Children and Adolescents

And know, that while monoclonal antibody treatments do have EUA for older children, a panel of pediatric experts has recommended against their routine use.

So get your kids vaccinated now and don’t think you can rely on monoclonal antibodies if they get sick…

More on COVID Treatments

Algorithms to Manage Common and Rare Pediatric Conditions

From an elevated ANA to a child with recurrent fractures, these evidence based clinical pathways, guidelines, and algorithms can help pediatricians figure out what’s the best next step for their patients.

What do you do when a baby has abnormal muscle tone, an elevated TSH, high blood pressure, or a high phenylalanine level ?

Do you refer them to a specialist for further management?

Or do you do a little research first, grabbing a few of your medical books?

There is an algorithm to help your pediatric provider figure out what to do if your kids have high blood pressure.
There is an algorithm to help your pediatric provider figure out what to do if your kids have high blood pressure.

Since these aren’t necessarily common things, you likely do need a little help to make sure you do the right thing, but on the other hand, you don’t have all day to research one problem…

So what do you do?

“Implementation of multiple evidence-based, standardized clinical pathways was associated with decreased resource utilization without negatively affecting patient physical functioning improvement. This approach could be widely implemented to improve the value of care provided.”

Standardized Clinical Pathways for Hospitalized Children and Outcomes

Having guidelines and algorithms to look to for some extra help would probably be nice…

Algorithms to Manage Common and Rare Pediatric Conditions

And here’s how you can quickly and easily find many of those guidelines and algorithms:

And of course, you can always look things up in a textbook, call your favorite expert, or refer your patient to a specialist if you need more help.

More on Managing Common and Rare Pediatric Conditions

What to Do if You Have Been Exposed to COVID-19

Folks need to understand that they should begin self-quarantine as soon as they learn that they have been exposed to someone with COVID-19.

Do you know what to do if you have been exposed to someone with COVID-19?

Because they could have been exposed to SARS-CoV-2, the virus that causes COVID-19, anyone who attended the party should self-isolate.
Because they could have been exposed to SARS-CoV-2, the virus that causes COVID-19, anyone who attended the party should self-isolate.

Hopefully you already know that you shouldn’t go to a party and expose lots of other folks…

What to Do if You Have Been Exposed to COVID-19

Unfortunately, lots of mistakes are being made that are causing COVID-19 cases to again rise.

“For COVID-19, a close contact is defined as anyone who was within 6 feet of an infected person for at least 15 minutes starting from 48 hours before the person began feeling sick until the time the patient was isolated.”

COVID-19 Frequently Asked Questions

One of them is that many people simply don’t understand the importance of self-quarantining themselves for 14 days (or consider one of the options to shorten your quarantine) after they have been exposed to SARS-CoV-2 if they aren’t fully vaccinated.

In addition to watching for symptoms, it is important to self-quarantine for 14 days after a COVID-19 exposure, the incubation period for SARS-CoV-2, something the Florida Department of Health forgets to mention...
In addition to watching for symptoms, it is important to self-quarantine for 14 days after a COVID-19 exposure, the incubation period for SARS-CoV-2, something the Florida Department of Health forgets to mention…

What happens if you don’t self-quarantine?

You may expose others in the days before you start to show symptoms (presymptomatic transmission).

But can’t you just get tested after your exposure to see if you have it?

Sure, you can get tested, but if it is negative and you are early in your incubation period, it doesn’t mean that you still won’t become sick later on. For example, you could have a negative COVID-19 test four days after being exposed to the virus, but then develop symptoms of COVID-19 two days later.

“Yes, you are still considered a close contact even if you were wearing a cloth face covering while you were around someone with COVID-19. Cloth face coverings are meant to prevent someone from transmitting the disease to others, and not to protect someone from becoming infected.”

COVID-19 Frequently Asked Questions

What if you’re not sure if you have COVID-19 and you are waiting on your test results?

That should be a no-brainer.

Self-isolate yourself why you are waiting for your COVID-19 test results!

Ideally, folks would be getting this information to self-quarantine after their COVID-19 exposure from a contact tracing team.
Ideally, folks would be getting this information to self-quarantine after their COVID-19 exposure from a contact tracing team.

And if you think you have COVID-19, be sure to tell all of your close contacts, which includes everyone who was within 6 feet of you for at least 15 minutes starting from 48 hours before you began feeling sick.

Of course, social distancing and wearing a mask are important too.

But folks need to understand that they should begin to self-quarantine as soon as they learn that they have been exposed to someone with COVID-19. That’s the easiest way to limit the spread of SARS-CoV-2 and the size of outbreaks.

More on COVID-19

What to Do if You Have Been Diagnosed with COVID-19

Do you know what to do if you get diagnosed with COVID-19?

Do you know what to do if you think you might be sick or have already been diagnosed with COVID-19?

What's worse than having a party when you have symptoms of COVID-19? How about refusing to cooperate with contact tracers who are trying to control an outbreak?
What’s worse than having a party when you have symptoms of COVID-19? How about refusing to cooperate with contact tracers who are trying to control an outbreak?

Hopefully you know that you shouldn’t host a party and expose lots of other folks…

What to Do if You Have Been Diagnosed with COVID-19

Unfortunately, lots of mistakes are being made that are causing COVID-19 cases to again rise.

“For COVID-19, a close contact is defined as anyone who was within 6 feet of an infected person for at least 15 minutes starting from 48 hours before the person began feeling sick until the time the patient was isolated.”

COVID-19 Frequently Asked Questions

One of them is that many people simply don’t understand the importance of staying away from others if they have been diagnosed (isolation) or exposed (self-quarantine) to SARS-CoV-2.

“If possible, have the person who is sick use a separate bedroom and bathroom. If possible, have the person who is sick stay in their own ‘sick room’ or area and away from others. Try to stay at least 6 feet away from the sick person.”

Caring for Someone Sick at Home

What happens if you don’t stay away from other people?

You may expose others, beginning in the days before you start to show symptoms (presymptomatic transmission).

Ideally, folks would be getting this information to self-quarantine after their COVID-19 exposure from a contact tracing team.
Ideally, folks would be getting this information to self-quarantine after their COVID-19 exposure from a contact tracing team.

Once you are diagnosed with COVID-19, be sure to tell all of your close contacts that they have been exposed, which includes everyone who was within 6 feet of you for at least 15 minutes starting from 48 hours before you began feeling sick. That way, if they aren’t fully vaccinated, then they can begin to self-quarantine and avoid exposing others if they get sick too.

How Long Will Your Quarantine Last?

How long will you have to stay home, away from other people?

It depends…

The CDC provides a variety of scenarios to help explain how long folks should stay in quarantine.
The CDC provides a variety of scenarios to help explain how long folks should stay in quarantine.

If you are in self-quarantine because you were exposed to someone with COVID-19, then you should stay home for 14 days after your last contact with that person. That’s the incubation period for the SARS-CoV-2 virus. Keep in mind that your quarantine restarts every time you have a new exposure, although there are now options to shorten your quarantine.

On the other hand, if you are in isolation because you have been diagnosed with COVID-19, then you should stay home until:

  • at least 10 days have passed since your positive test (if you have been asymptomatic)
  • you are fever free for at least three days, have improving respiratory symptoms, and it has been at least 10 days since your symptoms began

You might also be able to end your quarantine early if you have two negative tests in a row at least 24 hours apart, of course, while fever free and with improving respiratory symptoms.

If You Have COVID-19

What if you need to go to the doctor or ER after you have been diagnosed with COVID-19?

Call ahead so that they can be prepared and don’t end up exposing any staff or patients.

Hopefully you will have mild symptoms that will go away as you rest and stay hydrated, but if you develop emergency warning signs or symptoms (trouble breathing, chest pain, confusion, and trouble staying awake, etc.), then seek emergency care, being sure to mention that you have been diagnosed with COVID-19.

What if you need to go somewhere else?

You shouldn’t go anywhere or be around other people if you are in isolation after being diagnosed with COVID-19.

“People who are in isolation should stay home until it’s safe for them to be around others. In the home, anyone sick or infected should separate themselves from others by staying in a specific “sick room” or area and using a separate bathroom (if available).”

Isolate If You Are Sick

When in isolation, you should stay home except to get medical care.

What if you need food, medicine, or something else that you don’t have in your home? Ideally, you would order it and have it delivered, being sure to not expose the delivery person. If that isn’t an option, call your local support services for help.

More on COVID-19

7 Things to Know About COVID-19

Everything you need to know to reduce your risk of getting and exposing others to COVID-19.

We are far enough into this pandemic that there really is no excuse that folks still don’t know about the importance of going into quarantine after being exposed or why you should practice social distancing and wear a face mask.

As usual, Del Bigtree gets this one wrong. Hedrich wasn't the first to talk about herd immunity.
As usual, Del Bigtree gets this one wrong. Hedrich wasn’t the first to talk about herd immunity.

And yet, cases are once again surging all over the country…

7 Things to Know About COVID-19

In addition to knowing that the pandemic isn’t over and won’t be over for some time, you should know that:

  1. you could have been exposed to SARS-CoV-2 if you had close contact (less than 6 feet apart) to someone with COVID-19 (has symptoms or tested positive) for at least 15 minutes, even if you were both wearing masks (sure, there is much less risk if you were wearing masks, but to be safe, it still counts as an exposure). And with the latest guidelines, the exposure doesn’t have to for a continual 15 minutes, but rather “a cumulative total of 15 minutes or more over a 24-hour period.” So if you were close to someone with COVID-19 for 5 minutes each hour for three hours, then that counts as close contact. Fortunately, if you are fully vaccinated, this kind of close contact does not mean that you have to go into quarantine or get tested, unless you develop symptoms of COVID.
  2. you can develop symptoms of COVID-19 from one to 14 days after you are exposed to someone with COVID-19. This is the incubation period for the SARS-CoV-2 virus and the time you should be in quarantine after your exposure (although there are some new options to end quarantine early).
  3. testing negative soon after you are exposed to someone with COVID-19 doesn’t mean that you can’t develop symptoms later in your incubation period! Although testing is a very important part of containing this pandemic, you don’t necessarily need to rush to get tested right after you are exposed. You can, but understand that a negative test doesn’t get you out of your quarantine early. A positive test will shift you into a period of isolation, but know that some COVID-19 tests, especially the rapid antigen tests, are more likely to give a false positive result if you don’t have symptoms. If you are going to get tested after being exposed and don’t have symptoms, the optimal time is probably about 5 to 7 days after your exposure and remember to continue your quarantine if it is negative.
  4. you can be contagious for at least two days before you develop any symptoms of COVID-19 or test positive and will continue to be contagious for at least ten days, the time you should be in isolation (a stricter form of quarantine). If you had severe symptoms or have a severely weakened immune system, then you might be contagious for a much longer period of time though, up to 20 days. And remember that you can continue to test positive for weeks or months, long after you are no longer contagious, which is why repeat testing is no longer routinely recommended.
  5. you can be contagious even though you don’t have symptoms, which is why, if you are unvaccinated or high risk, you should try to always wear a mask and practice social distancing when you are around other people. You don’t know who has COVID-19!
  6. if you continue to be exposed to someone with COVID-19 in your home, your 14 day quarantine period doesn’t start until they are no longer contagious, as you will continue to be exposed that whole time. That’s why some folks end up in extended quarantine for 24 days- the 10 days that the COVID-19 positive person was contagious + 14 days of quarantine, which started once the person was no longer contagious.
  7. we can’t count on natural herd immunity to end the pandemic, as that would mean millions and millions of people dying. But understand that there is a middle ground between the extremes of total lockdowns and doing nothing. Wear a mask, keep six feet apart from other people (social distancing),and avoid crowds until you can get vaccinated and protected!

Most importantly, know that the more people you are around, the higher the risk that you will be exposed to and get sick with COVID-19.

Avoid crowded spaces, wear a mask, and practice social distancing to decrease your risk of getting COVID-19.
Avoid crowded spaces, wear a mask, and practice social distancing to decrease your risk of getting COVID-19.

Is it really essential that you have a family gathering with 25 or 50 people right now, as cases once again begin to surge in your area because of the Delta variant? Will you be able to keep everyone six feet apart? Will they be wearing masks the whole time?

Do you want to keep schools and businesses open?

Then get vaccinated and protected!

And if you can’t get a vaccine, wear a mask, practice social distancing, wash your hands, avoid crowds, and stop acting like the pandemic is already over or never existed in the first place!

More on COVID-19

How Many People Have Really Died With COVID-19?

There were at least 322,306 more deaths in 2020 than in 2019, which is about the number of deaths attributed to COVID-19.

Why do some people still not understand just how many people have died with COVID-19?

Why do some folks continue to push the idea that people aren't really dying with COVID-19?
Why do some folks continue to push the idea that people aren’t really dying with COVID-19? It makes it easier to convince you that you don’t need to wear a mask or get a COVID-19 vaccine…

The usual suspects…

How Many People Have Really Died With COVID-19?

If you are confused or doubt just how deadly COVID-19 has been, one easy way to estimate how many people have died with COVID-19 is to compare year-to-year total deaths.

Just over 2.8 million people died in 2018 and 2019.

For example, just over 2.8 million people died in 2018 and 2019.

In 2019, a total of 2,854,838 resident deaths were registered in the United States—15,633 more deaths than in 2018.

How does that compare to 2020?

Before you say that there were 2,913,144 deaths in 2020, keep in mind that this data doesn't include January 2020...
Before you say that there were 2,913,144 deaths in 2020, keep in mind that this data doesn’t include January 2020…

Not surprisingly, there were far fewer deaths in 2018 and 2019…

We add these 264,000 deaths from January 2020 to the 2,913,144 deaths from February to December 2020 to get our total for the year.
We add these 264,000 deaths from January 2020 to the 2,913,144 deaths from February to December 2020 to get our total for the year.

Using complete year counts:

  • 2019 total deaths – 2,854,838
  • 2020 total deaths – 3,177,144

Leaving you with 322,306 more deaths in 2020 than in 2019.

Which is just about the count of COVID-19 deaths that experts have posted.

If you still aren’t convinced that these deaths have been caused by COVID-19, if not COVID-19, then what has caused all of these extra deaths?

“Excess deaths provide an estimate of the full COVID-19 burden and indicate that official tallies likely undercount deaths due to the virus.”

Estimation of Excess Deaths Associated With the COVID-19 Pandemic in the United States, March to May 2020

The count is even more startling if you understand that many experts think that we are under-counting COVID-19 deaths!

“Simon and colleagues suggest that it is critical to consider that for every death, an estimated 9 family members are affected, such as with prolonged grief or symptoms of posttraumatic stress disorder. In other words, approximately 3.5 million people could develop major mental health needs. This does not account for the thousands of health care workers in hospitals and nursing homes who have been witness to the unimaginable morbidity and mortality associated with COVID-19.”

Excess Deaths and the Great Pandemic of 2020

What else?

Many people are underestimating their risk of what could happen if they get COVID-19. Or if one of their family members get COVID-19.

Sure, COVID-19 is much more deadly if you have risk factors, but many people still underestimate their risks of getting and dying from COVID-19.

With a case-fatality rate between 1 and 3% in the United States, that means a lot of people with COVID-19 have been dying.
With a case-fatality rate between 1 and 3% in the United States, that means a lot of people with COVID-19 have been dying.

The bottom line is that COVID-19 is indeed deadly, with the possibility of serious long-term effects for many who survive.

“While most persons with COVID-19 recover and return to normal health, some patients can have symptoms that can last for weeks or even months after recovery from acute illness.”

Long-Term Effects of COVID-19

And since we now have safe and effective COVID-19 vaccines that can help end the pandemic, you know what to do.

Over 500,000 people have now died with COVID-19 in the United States.
Over 500,000 people have now died with COVID-19 in the United States.

It’s time to get vaccinated and protected.

More on COVID-19 Deaths

Are We Going to See a Summer Surge of RSV This Year?

Folks need to understand that RSV might still be coming. If not in the next few months, then maybe this summer. And if there is no summer surge of RSV, then it will likely be back even worse next year.

A summer surge of RSV?

I know, it sounds ridiculous, right?

After all, in a typical year, RSV season begins in September or October and peaks in December or January.

Of course, this hasn’t been a typical year…

Are We Going to See a Summer Surge of RSV This Year?

Except for COVID-19, rhinovirus, enterovirus, and some adenovirus, we haven’t seen most of the seasonal viral outbreaks that we typically see each year.

There hasn't been any RSV in Texas this year.
There hasn’t been any RSV in Texas this year.

There was no RSV, flu, or seasonal coronavirus, etc.

Not that anyone has been complaining…

It was one of the bright spots that came out of all of the social distancing, mask wearing, and travel restrictions to control the COVID-19 pandemic!

So why would anyone think that we might see a summer surge of RSV?!?

The news that folks in Australia started getting hit with RSV a few months ago, when it was still summertime!

Remember, Australia is in the Southern Hemisphere and their summer runs from December to February and their autumn from March to May.
Remember, Australia is in the Southern Hemisphere and their summer runs from December to February and their autumn from March to May.

What caused the summer surge of RSV in Australia?

An unexpected surge that is also being reported in South Africa

“Recent reports from Australia described an inter-seasonal RSV epidemic in Australian children following the reduction of COVID-19–related public health measures from September 2020 to January 2021.”

Delayed Start of the Respiratory Syncytial Virus Epidemic at the End of the 20/21 Northern Hemisphere Winter Season, Lyon, France

Is it because they got their COVID-19 cases under good control early and relaxed many of their COVID-19 related public health measures, including eliminating mandates to wear masks and most restrictions on public gathering, and allowed kids to go back to school?

Whatever the reason for the surge, what is most troubling is that we may not have to wait until this summer for our own surge!

“In 2020, the first RSV cases of the 20/21 season were detected in Lyon at week 46 and 47 (Figure 1) at the same time of the southern hemisphere outbreak. A sustained detection of cases was observed from week 51, which is the expected time of the epidemic peak, to week 5. On week 6, the RSV epidemic was declared in the first French region (Ile de France) while the number of RSV cases has continued to increase in the Lyon population.”

Delayed Start of the Respiratory Syncytial Virus Epidemic at the End of the 20/21 Northern Hemisphere Winter Season, Lyon, France

France is seeing RSV too – with a 4 month delay to the start of their season. And they haven’t relaxed their physical distancing recommendations as much as Australia, as they were still seeing cases of COVID-19.

And as if all of that wasn’t enough, the summer surge of RSV in Australia is at rates that are much higher than is seen in a typical RSV season!

Wasn’t that expected?

“Our results suggest that a buildup of susceptibility during these control periods may result in large outbreaks in the coming years.”

The impact of COVID-19 nonpharmaceutical interventions on the future dynamics of endemic infections

While larger future outbreaks have been expected, most people likely thought they would start with next year’s season.

“Our findings raise concerns for RSV control in the Northern Hemisphere, where a shortened season was experienced last winter. The eventual reduction of COVID-19–related public health measures may herald a significant rise in RSV. Depending on the timing, the accompanying morbidity and mortality, especially in older adults, may overburden already strained healthcare systems.”

The Interseasonal Resurgence of Respiratory Syncytial Virus in Australian Children Following the Reduction of Coronavirus Disease 2019–Related Public Health Measures

I’m not sure anyone is ready for RSV and COVID-19 at the same time. That’s not the Twindemic folks were warning us about!

But maybe we should get ready to start seeing some RSV.

March is typically close to the end of RSV season, not the beginning.
March is typically close to the end of RSV season, not the beginning.

After all, rates of RSV are starting to increase in Florida and the South Atlantic division of the United States.

While there is no way to know if we will see this trend in other states and we may just be delaying when RSV season starts anyway, parents should know that we can always protect those who are most at risk from severe RSV disease.

“Ideally, people with cold-like symptoms should not interact with children at high risk for severe RSV disease, including premature infants, children younger than 2 years of age with chronic lung or heart conditions, and children with weakened immune systems.”

RSV Prevention

At some point, we might even have to consider changing when Synagis, the monthly shot that can help prevent RSV, is given. Should we continue giving Synagis to high risk infants this Spring and Summer, for example, instead of stopping in March?

Mostly, folks need to understand that RSV might be coming. If not in the next few months, then maybe this summer. And if not this summer, then it will likely be back with an even worse next year.

More on RSV

What is the Rule of Two/Too?

The Rule of Too/Two is an easy way to discover possible risks of genetic conditions in your family medical history.

Have you ever heard of the Rule of Two?

No, this isn’t about Star Wars…

What is the Rule of Two/Too?

If you didn’t know about the Rule of Two/Too, you will likely be very surprised to know that there are more than one of these rules!

The Rules of Two is a quick and easy way to figure our if your child's asthma is under good control.

The Rules of Two is a quick and easy way to figure our if your child’s asthma is out of control.

Remember that one now?

What about this other one?

The rule of Two/Too.

Arthur Grix proposed the Rule of Too/Two to make things simple for primary care providers when looking for genetic conditions within a family.
Arthur Grix proposed the Rule of Too/Two to make things simple for primary care providers when looking for genetic conditions within a family.

The Rule of Too/Two can help you figure out if you might have a genetic condition in your family!

After all, filling out your family medical history is pretty easy for most people. Knowing what to do with all of that information, especially how it might translate into a risk for a genetic condition is the tricky part…

“Family health history questions that result in answers using the descriptors “too” or “two”may indicate a genetic condition.”

A Toolkit to Improve Care for Pediatric Patients with Genetic Conditions in Primary Care

And that’s where the Rule of Too/Two comes in!

It reviews many of the red flags for genetic conditions and can help you figure out if you or your kids should undergo any kind of genetic screening.

The Rule of Too/Two includes:

  • being TOO tall as compared to their genetic potential for height
  • being TOO short as compared to their genetic potential for height
  • getting sick at TOO early/TOO young an age – extreme early onset cardiovascular disease, cancer, or renal failure, etc., and developing adult disorders in childhood can be a sign of a genetic cause
  • TOO many people in a family having the same condition
  • having an unusual or extreme presentation of a common condition that is TOO different than usual, like breast cancer in a male family member
  • a family member having TWO different types of tumors
  • a condition in TWO generations of family members
  • a condition that affects TWO people in the family
  • a family member with TWO or more birth defects or congenital anomalies

When you fill out your family health history, if you are using the terms ‘too’ and ‘two’ very often, then you might talk to your health care provider to take a closer look.

“Everyone is eligible for one tumor, one birth defect (ASD, cleft lip, birth mark, etc.).”

Arthur Grix, MD

The Rule of Too/Two is an easy way to discover possible risks of genetic conditions in your family medical history.

There are other genetic risk assessment methods besides the Rule of Too/Two.
There are other genetic risk assessment methods besides the Rule of Too/Two.

Which ever method you use, if you find genetic risks in your family tree, you might want to see a genetic counselor for further evaluation.

More on the Rule of Two/Too