Are Kids Dying With COVID-19?

How many children have died with COVID-19?

Breaking News – The CDC reports that there have been at least 121 SARS-CoV-2–associated deaths among persons aged <21 years, including 15 who died of MIS-C. (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 5% of cases in the United States have occurred in children and teens who are less than 18 years old, some of those “pediatric COVID-19 cases were hospitalized.”

The American Academy of Pediatrics reports at least 109 child deaths from COVID-19.
The American Academy of Pediatrics reports at least 109 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 mid-Sept, there have been over 967,000 COVID-19 deaths worldwide (all ages), including over 200,000 deaths in the United States (all ages).

“In China, the novel coronavirus has claimed the lives of a 10-month-old and a 14-year-old, at least.”

The coronavirus pandemic has claimed the lives of an infant and a teenager

And some of those deaths have been in children.

“Three deaths were reported among the pediatric cases included in this analysis; however, review of these cases is ongoing to confirm COVID-19 as the likely cause of death.”

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

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 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 109 COVID-19 deaths in children in the United States and cases are on the rise in many areas.

“During February 12–July 31, 2020, a total of 391,814 cases of COVID-19 and MIS-C (representing approximately 8% of all reported cases) and 121 deaths (approximately 0.08% of all deaths) were identified among persons aged <21 years in the United States.”

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

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 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 follow all social distancing recommendations.

More on COVID-19 Deaths

Are Kids Spreading SARS-CoV-2 in School and Daycare Centers

If kids aren’t spreading SARS-CoV-2, then why are three percent of the students at a high school in Texas sick with COVID-19?

Why are people starting to think that kids are spreading SARS-CoV-2, the virus that causing COVID-19, in school and daycare centers?

There have been over 500,000 cases of COVID-19 in children in the United States.
There have been over 500,000 cases of COVID-19 in children in the United States.

Probably because we are seeing more and more cases in kids, especially kids in daycare centers and schools in states with spiking cases.

SARS-CoV-2 in School and Daycare Centers

For example, let’s take a look at what’s going on in Texas…

“As of Friday, 410 total cases of coronavirus — 267 staff members and 143 children — had been reported at 318 licensed child care operations across the state, according to the Texas Health and Human Services Commission.”

Texas child care centers see sharp increase in coronavirus cases after months of relative calm

So far in Texas, 83% of child care centers (12,196 facilities are open) haven’t reported a COVID-19 case.

But 17% have…

Either in a child or adult.

Altogether, since March, there have been 1,271 cases in children and 2,416 cases in adults in 2,034 different daycare centers in Texas.

So far the largest cluster was in a Houston daycare, in which 17 adult staff members and 6 kids tested positive.

In another large cluster, in Pleasanton, 11 kids, but only 2 adult staff members tested positive.

COVID-19 has also already led to several school closures in Texas, just weeks after the start of the fall semester.

In one high school in East Texas, the number of active COVID-19 cases has already reached 3%. The school was only open for about three and a half weeks before having to move to online only education.

Are Kids Spreading SARS-CoV-2 in School and Daycare Centers?

A rise in cases in daycare centers doesn’t necessarily mean that it is the kids that are doing the spreading though.

Are staff members getting exposed and bringing SARS-CoV-2 to work with them, exposing the children? Or are the children acting as the spreaders?

A new study, Transmission Dynamics of COVID-19 Outbreaks Associated with Child Care Facilities — Salt Lake City, Utah, April–July 2020, provides some answers.

Children who likely got COVID-19 at two Utah daycare centers spread it to other family members at home.

These outbreaks all started with an infected staff member, but quickly spread to other staff members and children.

“Analysis of contact tracing data in Salt Lake County, Utah, identified outbreaks of COVID-19 in three small to large child care facilities linked to index cases in adults and associated with transmission from children to household and nonhousehold contacts. In these three outbreaks, 54% of the cases linked to the facilities occurred in children. Transmission likely occurred from children with confirmed COVID-19 in a child care facility to 25% of their nonfacility contacts.”

Transmission Dynamics of COVID-19 Outbreaks Associated with Child Care Facilities — Salt Lake City, Utah, April–July 2020

Not surprisingly, cases then spread outside the daycare centers, to some of the parents of these children and other family members at home.

Of course, that this study found evidence that children can spread SARS-CoV-2 isn’t surprising because it isn’t the first to make this claim.

“These findings demonstrate that SARS-CoV-2 spread efficiently in a youth-centric overnight setting, resulting in high attack rates among persons in all age groups, despite efforts by camp officials to implement most recommended strategies to prevent transmission. Asymptomatic infection was common and potentially contributed to undetected transmission, as has been previously reported.”

SARS-CoV-2 Transmission and Infection Among Attendees of an Overnight Camp — Georgia, June 2020.

There is also the report about children at the overnight camp in Georgia in June, which found an overall attack rate of 44% among the campers.

And the report about the Rhode Island COVID-19 daycare outbreaks.

“A total of 101 possible child care–associated COVID-19 cases were reported during June 1–July 31. Among them, 49 (49%) symptomatic persons were excluded after receiving negative laboratory test results, 33 persons (33%) had confirmed cases, and 19 (19%) were classified as having probable cases.”

Limited Secondary Transmission of SARS-CoV-2 in Child Care Programs — Rhode Island, June 1–July 31, 2020

Fortunately, community transmission of SARS-CoV-2 was lower in Rhode Island than many other states at the time, which is likely why “possible secondary transmission was identified in four of the 666 programs that had been allowed to reopen,” and not more.

Of course, these results stand in contrast to early reports in other countries which found that children didn’t seem to be spreading SARS-CoV-2.

“These data all suggest that children are not significant drivers of the COVID-19 pandemic. It is unclear why documented SARS-CoV-2 transmission from children to other children or adults is so infrequent.”

COVID-19 Transmission and Children: The Child Is Not to Blame

Early reports that were maybe flawed because children simply weren’t being exposed to SARS-CoV-2 at the time because of school closures and other factors.

“Here, we report that replication of SARS-CoV-2 in older children leads to similar levels of viral nucleic acid as adults, but significantly greater amounts of viral nucleic acid are detected in children younger than 5 years.”

Age-Related Differences in Nasopharyngeal Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Levels in Patients With Mild to Moderate Coronavirus Disease 2019 (COVID-19)

So with conflicting reports, what are we to believe?

What to Know About Kids Spreading SARS-CoV-2

We will have to see more research, but with cases continuing to increase in daycare centers, schools, and colleges, it is very hard to believe that kids aren’t spreaders of SARS-CoV-2.

Not that they have to be…

There is an easy way to keep kids from spreading SARS-CoV-2 at daycare, school, and college.

Even easier than making them wear masks.

A recent study in Germany found that child-to-child transmission of SARS-CoV-2 in schools/childcare facilities appeared very uncommon, but this was at a time of very low rates of community transmission.
A recent study in Germany found that child-to-child transmission of SARS-CoV-2 in schools/childcare facilities appeared very uncommon, but this was at a time of very low rates of community transmission.

Yes, that’s keeping the COVID-19 case count down in your community!

More on Kids Spreading COVID-19

Fact Check – Did a Doctor Prove That Face Masks Don’t Work?

A recently uploaded video on YouTube by an anesthesiologist doesn’t prove that face masks don’t work to protect people against COVID-19.

Why do some people still think that face masks don’t work to protect them and others against COVID-19 infections?

Ted Noel did not prove that face masks don't work in his YouTube video.
Ted Noel did not prove that face masks don’t work in his YouTube video.

The usual suspects…

Did a Doctor Prove That Face Masks Don’t Work?

Of course, most people understand that face masks work well to protect us from the SARS-CoV-2 virus and COVID-19 infections.

“Face masks are a simple way to help decrease coronavirus transmission and save lives.”

Which type of face mask is most effective against COVID-19?

Sure, not all types of face coverings are created equal, but if you are wearing a face mask when you can’t social distance, then you will help to reduce the spread of SARS-CoV-2.

And no, despite his claims and video on YouTube, Dr. Ted Noel, a retired anesthesiologist, did not prove that face masks don’t work!

As an anesthesiologist with 36 years of experience, you would think he would understand how a surgical mask is supposed to fit...
As an anesthesiologist with 36 years of experience, you would think he would understand how a surgical mask is supposed to fit…

What did he prove?

If you are vaping and exhale through a poorly fit face mask, then, not surprisingly, the “vape smoke” is going to find a way around your mask!

Will it go through your face mask ?

Again, not surprisingly, it depends on the type of face mask.

This is probably a single layer cloth mask and not one made with a recommended two or three layers.
This is probably a single layer cloth mask and not one made with a recommended two or three layers.

In Ted Noel’s little experiment, you can see that his cloth mask didn’t perform very well.

Interestingly, someone else had already done this face mask experiment and got widely different results!

Doctors Who Proved That Face Masks Do Work

And these results that face masks work have been shown in much more sophisticated experiments using high tech equipment, including high speed cameras and laser light scattering.

How much protection your face mask offers depends on the type of mask, but you can clearly see that face masks work!
How much protection your face mask offers depends on the type of mask, but you can clearly see that face masks work!

These experiments confirm that face coverings can block aerosols and droplets when we cough, sneeze, and breath. And since viruses like COVID-19 are carried on these droplets, they prove that masks work.

Well most face masks…

To make sure your face mask works effectively, you should:

  • use a face covering made of at least two layers of a washable, breathable fabric
  • avoid face masks with valves
  • use a properly fitting face mask instead of a neck gaiter or bandanna
  • avoid face coverings made with fleece
  • wash your cloth face mask

And don’t listen to or share misinformation from folks pushing propaganda about COVID-19.

“Among 139 clients exposed to two symptomatic hair stylists with confirmed COVID-19 while both the stylists and the clients wore face masks, no symptomatic secondary cases were reported; among 67 clients tested for SARS-CoV-2, all test results were negative. Adherence to the community’s and company’s face-covering policy likely mitigated spread of SARS-CoV-2.”

Absence of Apparent Transmission of SARS-CoV-2 from Two Stylists After Exposure at a Hair Salon with a Universal Face Covering Policy — Springfield, Missouri, May 2020

Face masks work!

More on Fact Checking Face Masks Work

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 694 confirmed cases of MIS-C and 11 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-threatenimiscng 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

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

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

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

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!

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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.

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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…

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