What is the COVID-19 Multi-System Inflammatory State?

Are kids with COVID-19 developing symptoms of Kawasaki disease?

Breaking News – The CDC reports at least 1,000 confirmed cases of MIS-C and 20 deaths in the United States. (see below)

Kids aren’t supposed to get serious COVID-19 symptoms, right?

As we are learning more and more about SARS-CoV-2, that seems to be holding true most of the time.

That doesn’t mean that kids are unaffected though.

Remember, it is still thought that kids get asymptomatic infections that they can spread to everyone else. And tragically, they sometimes get life-threatening infections.

What is the COVID-19 Multi-System Inflammatory State?

What else are we seeing when kids get SARS-CoV-2?

As they reassure parents that “serious illness as a result of COVID 19 still appears to be a very rare event in children,” the Paediatric Intensive Care Society issued a statement discussing an NHS England email alert about kids presenting with a type of multi-system inflammatory disease.

“The alert indicated ‘the cases have in common overlapping features of toxic shock syndrome and atypical Kawasaki disease with blood parameters consistent with severe COVID-19 in children. Abdominal pain and gastrointestinal symptoms have been a common feature as has cardiac inflammation’.”

PICS Statement: Increased number of reported cases of novel presentation of multi-system inflammatory disease

This statement followed the release of a study in Hospital Pediatrics, COVID-19 and Kawasaki Disease: Novel Virus and Novel Case, that discussed a similar case.

“We describe the case of a 6-month-old infant admitted and diagnosed with classic Kawasaki disease (KD), who also screened positive for COVID-19 in the setting of fever and minimal respiratory symptoms.”

Jones et al on COVID-19 and Kawasaki Disease: Novel Virus and Novel Case

And an alert of more frequent cases of Kawasaki disease in France and Italy.

“In several Italian centers, where the incidence of Covid-19 was higher – Professor Ravelli told ANSA – more frequent cases of Kawasaki disease have occurred than we have observed before the arrival of the coronavirus.”

Coronavirus: Prof. Ravelli, investigation of Kawasaki disease report (google translated)

And New York.

“The NYC Health Department contacted PICUs in NYC during April 29-May 3, 2020 and identified 15 patients aged 2-15 years who had been hospitalized from April 17-May 1,2020 with illnesses compatible with this syndrome (i.e., typical Kawasaki disease, incomplete Kawasaki disease, and/or shock).”

2020 Health Alert #13: Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19

Following a report of 15 cases in New York City, the New York State Department of Health issued an advisory to healthcare providers about 64 potential cases throughout the state.

As of 8/20/2020, CDC has received reports of 694 confirmed cases of MIS-C and 11 deaths in 42 states, New York City, and Washington, DC. Additional cases are under investigation.
As of 8/20/2020, CDC has received reports of 694 confirmed cases of MIS-C and 11 deaths in 42 states, New York City, and Washington, DC. Additional cases are under investigation.

And next came an alert from the CDC on what they are calling multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19).

MIS-C case definition

Most people will find the MIS-C case definition more helpful than the new name.

Also helpful is a recommendation to “report suspected cases to their local, state, or territorial health department.”

“This syndrome has features which overlap with Kawasaki Disease and Toxic Shock Syndrome. Inflammatory markers may be elevated, and fever and abdominal symptoms may be prominent. Rash also may be present. Myocarditis and other cardiovascular changes may be seen. Additionally, some patients have developed cardiogenic or vasogenic shock and required intensive care. This inflammatory syndrome may occur days to weeks after acute COVID-19 illness.”

Health Advisory: Pediatric Multi-System Inflammatory Syndrome Potentially Associated With Coronavirus Disease (Covid-19) in Children

So what does this mean?

It may means that we can add SARS-CoV-2 to the list of possible viruses that can trigger Kawasaki disease.

“Various studies have described an association between viral respiratory infections and KD, ranging from 9% to as high as 42% of patients with KD testing positive for a respiratory viral infection in the 30-days leading up to diagnosis of KD.”

Jones et al on COVID-19 and Kawasaki Disease: Novel Virus and Novel Case

And continue to be reassured that “serious illness as a result of COVID-19 still appears to be a very rare event in children.”

“If the above-described inflammatory syndrome is suspected, pediatricians should immediately refer patients to a specialist in pediatric infectious disease, rheumatology, and/or critical care,as indicated. Early diagnosis and treatment of patients meeting full or partial criteria for Kawasaki disease is critical to preventing end-organ damage and other long-term complications. Patients meeting criteria for Kawasaki disease should be treated with intravenous immunoglobulin and aspirin”

2020 Health Alert #13: Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19

Still, everyone should be on the alert for MIS-C, especially as COVID-19 cases once again surge.

More on COVID-19 in Kids

When New Moms Have COVID-19

Do the risks of separation outweigh the benefits when trying to avoid SARS-CoV-2 with a new baby?

Breaking News – The AAP has updated their guidance on newborns whose mothers have suspected or confirmed COVID-19. (see below)

Most of us are getting used to the idea of social distancing, staying home to flatten the curve, and the need to enter isolation if we actually get sick with COVID-19.

Isolation separates sick people with a quarantinable communicable disease from people who are not sick.”

Legal Authorities for Isolation and Quarantine

In most cases, even if you are in a home with other people, isolation is doable, as you just stay in your own room and keep away from everyone else.

When New Moms Have COVID-19

What about if a parent develops COVID-19?

Should they stay away from their kids?

Well, yeah. It might seem extreme, but you don’t want to intentionally get your kids sick!

Even if you just had a baby?

“It was devastating when they wheeled in the incubator. It hadn’t occurred to me they would even suggest it.”

New Mom who was treated as a PUI for COVID-19

That’s a tough one!

After all, we know that separating a newborn from their mother has consequences, just as there is a risk that a baby could get infected with SARS-CoV-2 if their mom has it.

The idea isn’t new though.

“If the mother has tuberculosis disease, the infant should be evaluated for congenital tuberculosis (see Congenital Tuberculosis, p 848), and the mother should be tested for HIV infection. The mother and the infant should be separated until the mother has been evaluated and, if tuberculosis disease is suspected, until the mother and infant are receiving appropriate antituberculosis therapy, the mother wears a mask, and the mother understands and is willing to adhere to infection-control measures.”

Tuberculosis – RedBook 31st Edition

We already recommend separating newborns from their mothers if they have active tuberculosis disease.

“The optimal length of temporary separation in the hospital has not been established, and will need to be assessed on a case-by-case basis after considering factors to balance the risk of mother-to-infant influenza virus transmission versus maintaining maternal-infant bonding.”

CDC on Influenza Guidance Prevention & Control in Peri- and Postpartum Settings

And if a mother “is ill with suspected or confirmed influenza,” which is another good reason to get your flu shot if you are pregnant!

“Mother-to-child transmission of coronavirus during pregnancy is unlikely, but after birth a newborn is susceptible to person-to-person spread.”

COVID-19 on Pregnancy and Breastfeeding

So what should you do?

Surprisingly, in this case, the answer depends on who you ask and where you live…

“The determination of whether or not to separate a mother with known or suspected COVID-19 and her infant should be made on a case-by-case basis using shared decision-making between the mother and the clinical team.”

CDC on Considerations for Inpatient Obstetric Healthcare Settings

The guidelines from the Centers for Disease Control and Prevention mentions the “risks and benefits of temporary separation of a mother with known or suspected COVID-19 and her infant,” and offers tips on what to do if separation is not undertaken.

What are the risks of separation?

Well, they don’t actually list any of them, but you might expect them to include:

  • trouble breastfeeding, especially if you are having to pump and someone else is feeding your baby formula or expressed breastmilk with a bottle instead of a supplemental nursing system
  • an increased risk for postpartum depression, especially as a recent stressful event, having inadequate social supports (social distancing makes getting help, even when you have a new baby, hard), and trouble breastfeeding are all risk factors for PPD. In this case, both COVID-19 and the separation would be stressful events that could put a new mother at increased risk for PPD.
  • having difficulty bonding with your baby once you get reunited, especially if it is a long separation

If you are going to make an informed decision, in addition to understanding the risks about your baby developing COVID-19, which can certainly be more severe in newborns and infants, it is important to know the risks of trying to avoid it.

Fortunately, any kind of separation for babies is typically brief.

Not surprisingly, the advice from the American Academy of Pediatrics seems more concrete.

“While difficult, temporary separation of mother and newborn will minimize the risk of postnatal infant infection from maternal respiratory secretions.”

AAP on INITIAL GUIDANCE: Management of Infants Born to Mothers with COVID-19

The INITIAL GUIDANCE from the AAP recommended separation and then, after hospital discharge, that mother’s with COVID-19 “maintain a distance of at least 6 feet from the newborn, and when in closer proximity use a mask and hand-hygiene for newborn care until (a) she is afebrile for 72 hours without use of antipyretics, and (b) at least 7 days have passed since symptoms first appeared.”

“Other caregivers in the home who remain under observation for development of COVID-19 should use standard procedural masks and hand hygiene when within 6 feet of the newborn until their status is resolved.”

AAP on INITIAL GUIDANCE: Management of Infants Born to Mothers with COVID-19

They have since updated that guidance, and while they still recommend separation as the “safest course of action,” because it is a controversial issue and separation has downsides, they now offer guidelines on what to do if mom chooses to room in with her baby.

They still advocate testing newborns if a mother is positive at about 24 hours of age, with repeat testing at 48 hours if the first test was negative.

In parts of the world where clean water is not guaranteed, exclusive breastfeeding might be essential to a baby’s survival. Did that influence the WHO’s guidance?

The advice from the World Health Organization is very different though!

They do not recommend any type of separation.

“Considering the benefits of breastfeeding and the insignificant role of breastmilk in the transmission of other respiratory viruses, the mother can continue breastfeeding, while applying all the necessary precautions.

For symptomatic mothers well enough to breastfeed, this includes wearing a mask when near a child (including during feeding), washing hands before and after contact with the child (including feeding), and cleaning/disinfecting contaminated surfaces – as should be done in all cases where anyone with confirmed or suspected COVID-19 interacts with others, including children.

If a mother is too ill, she should be encouraged to express milk and give it to the child via a clean cup and/or spoon – all while following the same infection prevention methods.”

UNICEF on Coronavirus disease (COVID-19): What parents should know

It is important to note that the WHO isn’t saying that you don’t have to take any precautions! Respiratory hygiene typically includes wearing a mask, as you can see described in the above recommendations from UNICEF, etc.

What about the American College of Obstetricians and Gynecologists (ACOG)?

“To reduce the risk of transmission of the virus that causes COVID-19 from the mother to the newborn, facilities should consider temporarily separating (eg, separate rooms) the mother who has confirmed COVID-19 or is a PUI from her baby until the mother’s transmission-based precautions are discontinued.”

ACOG Novel Coronavirus 2019 (COVID-19) Practice Advisory

They also recommend separation.

“Mothers with suspected or proven COVID-19 and their infants should not be completely separated. Mothers and infants should be allowed to remain together, after potential risks and benefits of rooming-in have been discussed and allowing for shared decision-making with families and their health care providers. There is some evidence to suggest that infants can be infected with SARS-CoV-2 postnatally.”

Canadian Paediatric Society on Breastfeeding when mothers have suspected or proven COVID-19

In contrast, pediatricians in Canada do not recommend separation!

“Mothers can practice skin-to-skin care and breastfeed while in hospital with some modifications to usual processes. Among the precautions, mothers should don a surgical/procedure mask when near their infant and practice proper hand hygiene before skin-to-skin contact, breastfeeding and routine baby care. Mother and baby should be discharged home as soon as they are deemed ready and then convalesce at home with guidance from the hospital.”

Canadian Paediatric Society on Breastfeeding when mothers have suspected or proven COVID-19

Like the WHO, they simply recommend advanced hygiene.

“If the mother has COVID-19, there may be more worry, but it is still reasonable to choose to breastfeed and provide expressed milk for her infant. Limiting the infant’s exposure via respiratory secretions may require more careful adherence to the recommendations depending on the mother’s illness.”

ABM Statement on Coronavirus 2019 (COVID-19)

It is important to note though that all organizations recommend continued breastfeeding, or at the very least that babies get expressed breastmilk if they are not able to actually nurse if separated from their mothers.

“SARS-CoV-2 has not been detected in breast milk to date.”

AAP on INITIAL GUIDANCE: Management of Infants Born to Mothers with COVID-19

Confused?

“One must weigh the risk of the newborn getting severe COVID-19 infection, which is rare but likely finite, with the risk of undermining the establishment of breastfeeding and the consequences of breastfeeding failure, which can be significant, particularly in low-income settings. Failure to establish breastfeeding could put the newborn at risk of food insecurity and other infections.”

COVID-19: Separating Infected Mothers from Newborns: Weighing the Risks and Benefits

What’s going to happen if you have a baby and you test positive for COVID-19?


UWMC Infant Care Guidelines for COVID-19

You will talk to your health care providers, who will help you make the best decision for you and your baby.

And know that both hospitals and your pediatric provider are well equipped to keep you and your baby safe from SARS-CoV-2.

More on When New Moms Have COVID-19

Are Kids Dying With COVID-19?

How many children have died with COVID-19?

Breaking News – The latest report from the CDC lists at least 1,537 pediatric COVID-19 deaths and 69 MISC deaths. (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 16% 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 1,055 child deaths from COVID-19.
The American Academy of Pediatrics reports at least 1,055 child deaths from COVID-19.

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

That makes it very hard to understand why some folks are still downplaying how COVID is affecting kids.

Are Kids Dying With COVID-19?

How many kids?

So far, as of mid-June, there have been over 6,311,088 COVID-19 deaths worldwide (all ages), including over 1,007,374 deaths in the United States (all ages).

And many of those deaths have been in children, including children who were previously healthy.

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:

And during the Omicron surge, the latest reports of COVID-19 deaths include:

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

Kids are dying with COVID-19, with Texas having the most pediatric COVID deaths.
Kids are dying with COVID-19, with Texas having the most pediatric COVID deaths.

Still, the AAP reports that there have been at least 1,055 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, the number of deaths is still 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 1,537 pediatric COVID-19 deaths.
The latest report from the CDC lists at least 1,537 pediatric COVID-19 deaths.

Keep in mind that there have been an additional 69 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 over 1,500 children have died with COVID-19.

And now we should ask why are kids continuing to die with COVID now that we have a safe and effective vaccine that can protect most of them?

More on COVID-19 Deaths

When was the First Case of COVID-19 in the United States?

SARS-CoV-2 was not around last winter. COVID-19 truly is a novel infection.

Why do some folks continue to believe that COVID-19 has been around for a while and that it isn’t as novel a virus as the rest of us know it really is?

Jay Gordon thinks that he might have been seeing a lot of kids with COVID-19 in January, well before the first confirmed cases in the state.
Jay Gordon thinks that he might have been seeing a lot of kids with COVID-19 in January, well before the first confirmed cases in the state.

The usual suspects…

When was the First Case of COVID-19 in the United States?

While some are wondering if they were seeing COVID-19 in January, some think they were seeing in even earlier.

#COVidiots are spreading the idea that COVID-19 has been in the United States since December.
#COVidiots are spreading the idea that COVID-19 has been in the United States since December.

Were the first cases of COVID-19 here in December?

“Yeah, me too. I’ve been telling almost every patient I see that, well, you know it’s flu season, but it doesn’t seem like you have the flu, it seems like you have a really bad cough. And everyone I’m seeing, it’s like their coughs are worse this winter. And their coughs are lasting for 3 or 4 weeks, instead of 1 or 2 weeks. And something went around this winter that was not the flu. Flu went around too, but there was a really terrible cold going around and you’re right, it is really possible in hindsight that coronavirus has been here this whole time.”

Bob Sears

What do you think of when you hear Bob Sears talk about seeing kids with a “really bad cough” that lingers for a month?

Since he wrote a book pushing a non-standard, parent-selected, delayed protection vaccine schedule, my first thought is pertussis too…

That isn't the COVID-19 type of coronavirus they are talking about in the cold and flu reports from December!

This has been a fairly bad flu season though, and as early as December, there were high rates of flu in many parts of the United States.

That isn’t the COVID-19 type of coronavirus they are talking about in the cold and flu reports from December!

And since it was cold AND flu season, there were already high rates of other cold viruses, including RSV, adenovirus, rhinovirus, enterovirus, and non-COVID-19 types of coronavirus.

Still, that doesn’t prove that the SARS-CoV-2 virus that causes COVID-19 wasn’t around in December or earlier.

So what evidence do we have?

Well, we have the evidence that the first strains of SARS-CoV-2 emerged in Wuhan, China in November.

“From very early on, it was clear that the nCoV genomes lacked the expected genetic diversity that would occur with repeated zoonotic events from a diverse animal reservoir. The simplest parsimonious explanation for this observation was that there was a single zoonotic spillover event into the human population in Wuhan between mid-Nov and mid-Dec and sustained human-to-human transmission from this point.”

Trevor Bedford on Early warnings of novel coronavirus from genomic epidemiology and the global open scientific response
The first case of 2019 Novel Coronavirus was detected in Washington in January.

And we know that the first cases in the United States were seen in Washington in mid January.

Genomic epidemiological analysis traced the first case in Washington to a traveler from China in mid January.
Genomic epidemiological analysis traced the first case in Washington to a traveler from China in mid January.

Wait, how do “we” know that?

“The field of genomic epidemiology focuses on using the genetic sequences of pathogens to understand patterns of transmission and spread. Viruses mutate very quickly and accumulate changes during the process of transmission from one infected individual to another. The novel coronavirus which is responsible for the emerging COVID-19 pandemic mutates at an average of about two mutations per month.”

Trevor Bedford on Cryptic transmission of novel coronavirus revealed by genomic epidemiology

We know that because experts can examine the small mutations in the SARS-CoV-2 virus when it emerges in an area.

“We know that Wuhan went from an index case in ~Nov-Dec 2019 to several thousand cases by mid-Jan 2020, thus going from initial seeding event to widespread local transmission in the span of ~9-10 weeks. We now believe that the Seattle area seeding event was ~Jan 15 and we’re now ~7 weeks later.”

Trevor Bedford on Cryptic transmission of novel coronavirus revealed by genomic epidemiology

That has helped them track where and when the SARS-CoV-2 virus pops up in each part of the country.

The SARS-CoV-2 virus in each area is different enough that they can trace where it came from, but no, the differences aren't large enough to affect immunity.
The SARS-CoV-2 virus in each area is different enough that they can trace where it came from, but no, the differences aren’t large enough to affect immunity.

No we don’t have a time machine to test folks in November or December or even earlier, except to test those who submitted specimens in flu studies (which will be done as folks get caught up with testing new samples), but by examining the mutations in the virus, they can tell how long the virus has been spreading in each area.

And that has allowed them to create fairly detailed timelines of SARS-CoV-2 outbreaks in the United States.

Do any of these timelines show COVID-19 cases in the United States in December or early January?

Nope.

Is there any good reason you should be listening to the folks pushing misinformation about COVID-19?

Of course not!

Not surprisingly, these are the same folks who are well known to push misinformation about vaccines.

But why do they want you to think that SARS-CoV-2 has been around for awhile?

It’s propaganda to make you think that getting COVID-19 isn’t that serious.

Don’t believe them.

More on the First Case of COVID-19 in the United States

About Those Rapid COVID-19 Tests

A company is selling rapid COVID-19 tests that promise quick results in 10 minutes. The only problem? They are not approved by the FDA…

While everyone has been talking about tests for SARS-CoV-2 infections, it is mostly the PCR tests from nasopharyngeal swabs that take a few days to get results.

The PCR tests that nobody can really get their hands on…

About Those Rapid COVID-19 Tests

Now, in addition to more and more of those tests becoming available every day, many folks are excited about rapid tests.

How rapid?

“The Food and Drug Administration has approved the first rapid point-of-care COVID-19 test, that can deliver results in less than an hour.”

FDA Approves First Rapid COVID-19 Test

The new COVID-19 test, from Cepheid, provides results, also from a nasal swab, in about 45 minutes.

Most importantly, like strep and flu tests, this new COVID-19 rapid test doesn’t have to be sent anywhere. That doesn’t mean that your pediatrician will be able to see you and run a rapid COVID-19 test anytime soon though.

“The test has been designed to operate on any of Cepheid’s more than 23,000 automated GeneXpert Systems worldwide, with a detection time of approximately 45 minutes.”

Cepheid Receives Emergency Use Authorization from FDA for Rapid SARS-CoV-2 Test

It needs the specialized, and expensive, GeneXpert System to run.

Who has these systems?

Mostly hospital labs.

And that’s great news!

Even if the test could be run in your pediatrician’s office, a lack of personal protective equipment would still limit how much testing they could do.

On the other hand, a fast test that could be run in big hospitals will help them set up centralized, mobile testing centers.

Unfortunately, in addition to the very real rapid COVID-19 test from Cepheid, we are seeing many other rapid tests pop up that are not FDA approved!

COVID-19 test results in 10 minutes? From a blood sample?
COVID-19 test results in 10 minutes? From a blood sample?

Among the tests that you should be especially wary of are those that say they give quick results from a blood sample – a serology test.

“Initial work to develop a serology test for SARS-CoV-2 is underway at CDC. In order to develop the test, CDC needs blood samples from people who had COVID-19 at least 21 days after their symptoms first started. Researchers are currently working to develop the basic parameters for the test, which will be refined as more samples become available. Once the test is developed, CDC will need additional samples to evaluate whether the test works as intended.”

Serology Test for COVID-19

Unfortunately, these types of serology tests which look at antibody levels are not yet available – at least they aren’t available in the United States.

Several companies have begun the application process with the FDA under the COVID-19 Emergency Use Authorization (EUA) though.

We will have to see if they really work and how long it takes for them to get approved.

What else isn’t available yet? There are no FDA approved home COVID-19 test kits, even though many companies and some physicians are selling them…

More on Rapid COVID-19 Tests

Mixed Messages About COVID-19

Don’t let mixed messages about COVID-19 leave you confused or get in your way of preparing your family for this new pandemic.

Do you feel like you are getting mixed messages about COVID-19?

Don’t stockpile things, but be prepared.

Don’t wear a mask, but avoid other people so you don’t get sick.

It’s just like a bad flu, but states are declaring states of emergency and countries are restricting travel.

Mixed Messages About COVID-19

Are you confused yet?

Are you wondering why we continue to see new cases?

Have you forgotten that we were warned that SARS-CoV-2 would likely become a pandemic?

“With the inexorable spread of 2019-nCoV, we are again upset about the way officials and reporters are talking about containment. We think it is crucial to try to prepare the public for the very high likelihood that containment WILL FAIL, if what we mean by “containment” is that we might be able to stop a pandemic.”

Risk Communication about Containment – 2019 Novel Coronavirus

Shouldn’t we have been able to stop it if we had warning?

Although ideally we would have contained SARS-CoV-2 before we started to see community spread, the more realistic goal has been slowing down its spread.

Containment measures can help to flatten the curve in a pandemic, buying everyone some more time to get ready.

Slowing down its spread will help prevent everyone from getting sick all at once so that doctors and hospitals don’t get overwhelmed.

Wait, is everyone going to get sick?

That’s probably another thing about COVID-19 that has you confused.

And the answer is almost certainly no.

There likely won’t be constant exponential growth and like many other respiratory diseases, this one will hopefully end at some point.

We shouldn’t expect exponential growth of COVID-19, which means that everyone isn’t going to get it over the next few months.

It is also very important to understand that most of the people who do get sick will have a mild illness.

So if we can’t stop it and most cases are mild, then why are we declaring emergencies, closing schools, and canceling some large community events?

“That this disease has caused severe illness, including illness resulting in death is concerning, especially since it has also shown sustained person-to-person spread in several places.”

Coronavirus Disease 2019 (COVID-19) Situation Summary

It is because we are still learning about this new virus and we already know that it can cause severe, even life-threatening disease, in some people.

Why are we trying to slow down the COVID-19 pandemic?

So what should you do?

“Call your doctor: If you think you have been exposed to COVID-19 and develop a fever and symptoms of respiratory illness, such as cough or difficulty breathing, call your healthcare provider immediately.”

Prevent the spread of COVID-19 if you are sick

Be prepared.

There is a lot of good information out there from the CDC, WHO, and your local and state health department to help you get prepared for COVID-19.

Most importantly, be smart and do all of the common sense things that we always talk about that can help keep you from getting sick, like washing your hands and not touching your eyes, nose, or mouth, etc.

And if you are in a high risk group, or have frequent contact with someone in a high risk group, you should likely be a little extra careful to help reduce your chances of getting COVID-19. That’s when you might take the extra steps of avoiding crowds and limiting contact with others, etc.

“Stay home: People who are mildly ill with COVID-19 are able to isolate at home during their illness. You should restrict activities outside your home, except for getting medical care.”

Prevent the spread of COVID-19 if you are sick

What’s next?

As testing becomes more widely available in the coming days and weeks, you can almost certainly expect to hear about more and more cases in more and more parts of the United States.

Don’t be surprised.

Be prepared.

More on Mixed Messages About COVID-19

Kids and COVID-19

Kids might not be at big risk from COVID-19, but that doesn’t mean that they are immune from stress and anxiety from hearing about it all of the time.

One good piece of news that is easy to pick out from all of the doom and gloom about COVID-19 is that kids don’t really seem to be at extra risk from this new disease.

“In this preliminary description of pediatric U.S. COVID-19 cases, relatively few children with COVID-19 are hospitalized, and fewer children than adults experience fever, cough, or shortness of breath. Severe outcomes have been reported in children, including three deaths.”

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

So far, fewer than 2% of cases in the United States have occurred in children and teens who are less than 18 years old. And of those who did get COVID-19, “relatively few pediatric COVID-19 cases were hospitalized” and even were admitted to the ICU.

Many did not even have a fever or cough!

That’s good news, as kids are often in high risk groups and at extra risk for other infectious diseases, like flu, measles, and RSV.

Kids and COVID-19

So why don’t kids get infected by SARS-CoV-2 more often?

“There have been very few reports of the clinical outcomes for children with COVID-19 to date. Limited reports from China suggest that children with confirmed COVID-19 may present with mild symptoms and though severe complications (acute respiratory distress syndrome, septic shock) have been reported, they appear to be uncommon.”

Children and COVID-19

Well, we actually don’t know how many kids are getting SARS-CoV-2…

Right now, it just seems like most don’t get severe disease, but because of limited testing and a priority going to those with severe disease, it may be that many more kids are infected than we know.

“Though the evidence to date suggests this virus doesn’t inflict severe disease on children, there’s reason to think kids may be helping to amplify transmission. It’s a role they play to devastating effect during flu season, becoming ill and passing flu viruses on to their parents, grandparents, teachers, and caregivers.”

A critical question in getting a handle on coronavirus: What role do kids play in spreading it?

They could just be getting very mild disease or infection without symptoms.

While that’s certainly reassuring, we can’t ignore the possibility that kids could get and spread the SARS-CoV-2 virus to others in high risk groups, including older people and people with severe chronic health conditions.

“If parents seem overly worried, children’s anxiety may rise. Parents should reassure children that health and school officials are working hard to ensure that people throughout the country stay healthy. However, children also need factual, age appropriate information about the potential seriousness of disease risk and concrete instruction about how to avoid infections and spread of disease.”

Talking to Children About COVID-19 (Coronavirus): A Parent Resource

And we shouldn’t forget that there is one thing that children aren’t immune to right now – anxiety from hearing about COVID-19 all of the time!

More on Kids and COVID-19

What is the COVID-19 Mortality Rate?

Do we know how deadly COVID-19 really is?

Knowing the COVID-19 mortality rate would help folks get a better understanding of just how concerned they should be about this new disease that is quickly spreading around the world.

New modeling from the CDC puts the COVID-19 case fatality rate at 0.1 to 1%.

Unfortunately, the widely different numbers we are hearing might contribute to some of the confusion people already have about the SARS-CoV-2 virus.

What is the COVID-19 Mortality Rate?

In general, the mortality rate for a disease is “the measure of the frequency of occurrence of death in a defined population during a specified interval.”

Defined population?

That’s not how many people have the disease. That’s literally how many people there are in the place you are talking about.

Instead of mortality rate, right now, what we really want to be talking about is the case fatality rate.

“The case-fatality rate is the proportion of persons with a particular condition (cases) who die from that condition. It is a measure of the severity of the condition.”

Mortality Frequency Measures

Still, differences in defining the “population” or cases has lead to differences in reports of case fatality rates from the CDC and WHO.

“There is now a total of 90,893 reported cases of COVID-19 globally, and 3110 deaths.”

WHO Director-General’s opening remarks at the media briefing on COVID-19 – 3 March 2020

The WHO reports a case fatality rate of 3.4% for COVID-19, which they get by simply dividing the 3,110 deaths by the 90,893 reported cases.

“This crude CFR is high: for comparison, the CFR for seasonal influenza is 0.1%. However, as I will show below, this number is not a one-size-fits all, and is influenced by many factors. Please do not look at 3.4% as an indicator of your risk of dying from COVID-19!”

SARS-CoV-2 coronavirus case fatality ratio

The CDC, on the other hand, is using a method that factors in the idea that there are likely many more mild cases that haven’t been officially reported. That gets them a much lower case fatality rate rate of 0.1 to 1%.

Only more testing will get us a more accurate case fatality rate for COVID-19.
Only more testing will get us a more accurate case fatality rate for COVID-19.

Then there is the large study on COVID-19 case fatality rates that did include suspected and asymptomatic cases, Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China. They found an overall case-fatality rate (CFR) of 2.3%.

“Epidemiologists think and quibble in terms of numerators and denominators—which patients were included when fractional estimates were calculated, which weren’t, were those decisions valid—and the results change a lot as a result.”

COVID-19 Isn’t As Deadly As We Think

What do these numbers mean to you?

They might be easier to understand if you compare the case fatality rate of COVID-19 to some other diseases.

DiseaseCase Fatality Rate
Rabies99.9%
H5N1 bird flu60%
Ebola50%
MERS34%
H7N9 bird flu25%
SARS15%
Yellow fever15%
Tetanus13%
Diphtheria5-10%
1918 flu pandemic1-3%
COVID-19*0.1-3%
2009 flu pandemic0.1%
Seasonal flu0.1%
Measles0.1%
A high case fatality rate doesn’t tell the whole story. It is also important to understand how likely it is for a disease to spread and get a lot of people sick. And a reminder that many vaccine preventable diseases are quite deadly!

Fortunately, COVID-19 is near the bottom of the list, and as we get more and more data, it seems like the official case fatality rate will continue to drop.

Still, since it is spreading at pandemic levels, that means a lot of people will get sick and could die, especially those in high risk groups.

Older people and people with severe chronic health conditions are likely at higher risk COVID-19 infections.
Older people and people with severe chronic health conditions are likely at higher risk for COVID-19 infections.

*How many? It’s too early to tell, as we really don’t know what the real COVID-19 case fatality rate is yet.

“Practice everyday preventive behaviors! Stay home when sick. Cover coughs and sneezes. Frequently wash hands with soap and water. Clean frequently touched surfaces.”

Preventing COVID-19 Spread in Communities

That makes it important to take steps to try and slow down the spread of SARS-CoV-2, especially to people who are at high risk.

More on the COVID-19 Fatality Rate

Should You Be Tested for COVID-19?

More tests for COVID-19 are now available, but not everyone needs to be tested, especially if they don’t have symptoms.

As SARS-CoV-2 infections continue to spread, many people are probably wondering if they should be tested for COVID-19.

“To learn if you have a current infection, viral tests are used. Most people have mild illness and can recover at home without medical care. Contact your healthcare provider if your symptoms are getting worse or if you have questions about your health.​​”

CDC on Testing for COVID-19

While it might sound like a good idea, especially if there are many COVID-19 cases in your area, getting tested for SARS-CoV-2 isn’t as easy as you might think it should be…

Should You Be Tested for COVID-19?

What’s the biggest problem with getting tested for SARS-CoV-2?

Since this is a new infection, a new test had to be developed to detect it.

And believe it or not, that test is still not widely available.

“The California Department of Public Health announced today that new CDC test kits used to detect Coronavirus Disease 2019 (COVID-19) now available in California can be used to do diagnostic testing in the community. California will immediately receive an additional shipment of kits to test up to 1,200 people.”

COVID-19 Testing Kits Arrive at State Public Health Laboratories

While more and more communities now have COVID-19 test kits, getting tested often still means a long wait for the test and an even longer wait for the results.

The CDC is now shipping its laboratory test kit for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to qualified state and local public health laboratories.
The CDC is now shipping its laboratory test kit for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to qualified state and local public health laboratories.

But what happens if you think that you have COVID-19?

Can you get tested?

While there were originally strict criteria for who could get a test, including folks with COVID-19 symptoms, those who had contact with a known case, and anyone with recent travel to a hot spot, it has gotten to where almost anyone can get a test.

Not everyone needs a test though…

“Can someone test negative and later test positive on a viral test for COVID-19?

Yes, it is possible. You may test negative if the sample was collected early in your infection and test positive later during this illness. You could also be exposed to COVID-19 after the test and get infected then. Even if you test negative, you still should take steps to protect yourself and others.”

COVID-19 Frequently Asked Questions

Should you get tested if you were exposed to someone with COVID-19?

While it might seem like a good idea, understand that if you test negative, it doesn’t mean that you won’t develop symptoms and test positive later on in your incubation period (up to 14 days).

Are you going to get tested every day?

So no, you probably don’t need to be tested simply because you were exposed. You should self-quarantine yourself though and can consider testing if you later develop symptoms.

And you likely don’t need to get tested if you weren’t a close contact (within 6 feet of an infected person for at least 15 minutes) of someone with COVID-19. Besides the fact that testing is still limited and should likely be reserved for those with symptoms, a negative test one day simply means that you are negative that day. Again, you could develop symptoms the next day or even later that day…

What Tests Are Used to Diagnose Covid-19?

If you are going to get tested for COVID-19, do make sure you get the right test though.

“A viral test tells you if you have a current infection.”

CDC on Testing for COVID-19

You want to get a viral test (preferably the PCR test, as it is more reliable than the antigen test), and not the antibody test (blood test), which detects past infections.

Remember though, since there is no specific treatment for COVID-19, the only thing a positive test does is reinforce your need for self-isolation.

“For COVID-19, the period of quarantine is 14 days from the last date of exposure, because 14 days is the longest incubation period seen for similar coronaviruses.”

COVID-19 Frequently Asked Questions and Answers

Testing can help identify folks who really need to be quarantined, keeping them from getting others sick, and it can help with contact tracing.

While that can be useful, it is also important to understand that the COVID-19 tests can have false-negative results. So if you think you have symptoms of COVID-19, stay in quarantine even if you have a negative test.

What to Know About COVID-19 Testing

More tests for COVID-19 are now available, but not everyone needs to be tested, especially if they don’t have symptoms.

More on COVID-19 Testing

COVID-19 Hype or Hazard

Hopefully you are concerned, but aren’t panicking about the new coronavirus that is all over the news right now.

Breaking News: we have seen community spread in the US, at least nine 41 deaths, and more cases in more states. (see below)

What do you think of the news of the 2019 novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)?

Experts say don't panic about the 2019 novel coronavirus.

Are you ready to put on a mask, never leave your home, or just wait and see what happens?

COVID-19 Hype or Hazard

Hopefully you are concerned, but aren’t panicking and want to wait and see what happens over the next few days, weeks, and months.

So what’s going on?

A new coronavirus, 2019-nCoV SARS-CoV-2 has been detected in Wuhan, China and it is spreading, killing some people.

Why is this a concern?

While there are coronaviruses that are very common, even causing many cases of the common cold, there are others that are much more serious.

Seasonal coronavirus are very common during cold and flu season.
Seasonal coronavirus are very common during cold and flu season.

These include the coronaviruses that cause SARS and MERS.

A worldwide outbreak of severe acute respiratory syndrome caused by SARS-CoV caused 8,098 cases and 774 deaths in 2002-03. It also started in China.

MERS-CoV, which causes Middle East Respiratory Syndrome, has been causing cases and deaths since 2012.

What’s Next With COVID-19?

Why are experts concerned about SARS-CoV-2?

Check for Travel Alerts and Warnings before your next trip.
Check for Travel Alerts and Warnings before your next trip.

Mostly because of past experiences with SARS and MERS.

There is also the fact that there is no treatment or vaccine for 2019-nCoV.

Coronavirus that shows up on those large respiratory panels that some health providers do is seasonal coronavirus = the common cold.
Coronavirus that shows up on those large respiratory panels that some health providers do is seasonal coronavirus = the common cold.

And no, your doctor won’t be able to routinely test you for SARS-CoV-2. Testing can be done for those who are high risk, but it still involves sending the specimens to a lab at your local or state health department or the CDC.

That shouldn’t put you into panic mode though…

“Two cases of 2019-nCoV have been reported in the United States. Both patients had recently returned from Wuhan, China. More cases are likely to be identified in the coming days, including more cases in the United States.”

COVID-19 Frequently Asked Questions

Unless you have recently traveled to Wuhan, China an area where there is a COVID-19 outbreak or have had close contract with someone who traveled to an area with a lot of cases while they were sick, then you likely aren’t at much risk to get sick with this virus.

“For the general American public, who are unlikely to be exposed to this virus at this time, the immediate health risk from COVID-19 is considered low.”

Coronavirus Disease 2019 (COVID-19) Situation Summary

It is certainly not something to ignore though.

Since first being detected in Wuhan, China on December 29, 2019, cases have spread to 28 41 46 64 72 134 other countries.

“More cases are likely to be identified in the coming days, including more cases in the United States. It’s also likely that person-to-person spread will continue to occur, including in the United States.”

Coronavirus Disease 2019 (COVID-19) Situation Summary

Most experts expect SARS-CoV-2 to become a pandemic, but that still shouldn’t put you into panic mode…

Experts are also working to learn more so that we know:

  • the original source of the virus – is it the animal markets in Wuhan, China?
  • the incubation period – it seems to be 1 to 14 days
  • how contagious the virus can be and how it spreads – close contact
  • how serious are the complications of infection or how deadly is this virus – so far, “reported illnesses have ranged from mild to severe, including illness resulting in death,” but the latest worldwide mortality rate of 1.4 to 3.4% is much higher than seasonal flu
  • can the virus be contained – this seems unlikely…

We got one answer recently, as it seems that people with the virus are contagious before they have symptoms.

What’s next?

Don’t panic. Plan ahead.

Stay up to date on SARS-CoV-2 information and call your health care provider if you have flu-like symptoms and recently traveled to Wuhan, China or had contact with someone who is under investigation for COVID-19.

“Limited reports of children with COVID-19 in China have described cold-like symptoms, such as fever, runny nose, and cough. Gastrointestinal symptoms (vomiting and diarrhea) have been reported in at least one child with COVID-19. These limited reports suggest that children with confirmed COVID-19 have generally presented with mild symptoms, and though severe complications (e.g., acute respiratory distress syndrome, septic shock) have been reported, they appear to be uncommon.”

CDC on Frequently Asked Questions and Answers: Coronavirus Disease-2019 (COVID-19) and Children

And even if you are starting to get nervous, at least you don’t have to worry too much about your kids. So far, there is no evidence that children are more susceptible to COVID-19 and there are reports that they actually get milder symptoms!

Lastly, if you haven’t yet, be sure to get a flu vaccine.

Affected geographic areas include China, Italy, South Korea, Iran, and Japan.
As we see community spread in more areas, the criteria to guide evaluation of PUI for COVID-19 continues to loosen up.

If you are going to develop a fever and symptoms of lower respiratory illness during cold and flu season in the United States, especially if you haven’t traveled to a high risk area, then it is probably the flu, not the new coronavirus…

More on COVID-19 Hype or Hazard

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