Those COVID-19 Death Comparisons

Don’t be mislead by the folks making false comparisons about COVID-19 deaths.

Have you seen folks trying to compare COVID-19 deaths to other things?

What other things?

All Dr. Phil revealed was that he shouldn't have been talking about COVID-19...
All Dr. Phil revealed was that he shouldn’t have been talking about COVID-19…

Basically anything and everything, from smoking, drowning, and car accidents to the flu…

Those COVID-19 Death Comparisons

It’s not that surprising that those comparisons were made when the COVID-19 pandemic first got going.

It’s like Jenga?

But it is disappointing that some folks are still making these arguments.

“I’m not denying what a nasty disease COVID-19 can be, and how it’s obviously devastating to somewhere between 1 and 3.4 percent of the population. But that means 97 to 99 percent will get through this and develop immunities and will be able to move beyond this. But we don’t shut down our economy because tens of thousands of people die on the highways. It’s a risk we accept so we can move about. We don’t shut down our economies because tens of thousands of people die from the common flu.”

Senator Ron Johnson of Wisconsin, chairman of the Senate’s Committee on Homeland Security and Governmental Affairs

What’s even worse, they seem to be using the arguments to discourage others from social distancing and wearing masks!

Fortunately, most people understand that you can’t really compare COVID-19 deaths to those other things.

It is like comparing apples to oranges. Sure, they are both fruits, but they aren’t the same kinds of fruits.

So why do some people make these false comparisons?

They do it to make you think that both sides of the argument are the same or are equal. After all, it makes easier to downplay COVID-19 deaths if ‘they’ can make you think they are the same as deaths from car accidents, drownings, and the flu, etc.

Instead of the death rate, it is more appropriate to use the case-fatality rate, which factors in the folks who actually had COVID-19.
Instead of the death rate, it is more appropriate to use the case-fatality rate, which factors in the folks who actually had COVID-19.

So why shouldn’t you make these comparisons?

For one thing, deaths from COVID-19 spiked suddenly. They haven’t been spread out over a year or many years, like deaths from car accidents, drownings, and cigarette smoking, etc..

“The demand on hospital resources during the COVID-19 crisis has not occurred before in the US, even during the worst of influenza seasons. Yet public officials continue to draw comparisons between seasonal influenza and SARS-CoV-2 mortality, often in an attempt to minimize the effects of the unfolding pandemic.”

Faust et al on Assessment of Deaths From COVID-19 and From Seasonal Influenza

Also, unlike car accidents and drownings, COVID-19 is contagious.

And don’t forget, we go to great lengths to reduce deaths from car accidents and drownings, with everything from seat belts, air bags, and life jackets to fencing around swimming pools and laws against distracted driving.

Does anyone say “life is about risk,” while throwing their toddler in the pool and walking inside?

We make efforts to reduce that risk!

What is your risk of being in a car accident?
What is your risk of being in a car accident?

We also go to some effort to understand those risks…

“If we overestimate our risk in one area, it can lead to anxiety and interfere with carrying out our normal daily routine. Ironically, it also leads us to underestimate real risks that can injure or kill us.”

National Safety Council on Odds of Dying

So what is your risk of being in a car accident?

Believe it or not, it is fairly low, with the average person filing a claim for a car accident once every 17.9 years.

And since only about 3 in 1,000 car accidents are fatal, the chance of you being in a fatal motor vehicle accident is also fairly low.

“The total number of confirmed COVID-19 deaths in the U.S. exceeds 115,000, outnumbering each of the leading causes of preventable injury death (58,908 preventable drug overdose deaths, 39,404 motor-vehicle deaths, and 37,455 fall deaths in 2018). However, the full impact of COVID-19 is even greater than the number of deaths and confirmed cases. The rapid increase in COVID-19 cases, the uncertainty regarding how long the pandemic will last and the disruption to normal everyday activities is impacting society like no other safety issue in modern history.”

COVID-19 Cases in the United States

How does that compare to getting and dying from COVID-19?

Where do you live? Are folks around you wearing a mask?

If you are working from home in a small town with few COVID-19 cases, then your risk is obviously much, much lower than someone who works around the public in a bigger city with rising case counts.

Do you have any risk factors for a more severe case of COVID-19?

While the overall case fatality rate is about 1%, that starts to go up as you approach age 50 and is higher for those with many chronic health conditions.

Most importantly, what are you doing to lower that risk?

Just like your risk of dying in a car accident is going to be much higher than average if you drink and drive, don’t wear a seat belt, talk on your phone, and speed, your risk of getting and dying from a SARS-CoV-2 infection is going to be higher if you live in or travel to an area with a lot of cases, are around a lot of people who aren’t social distancing or wearing masks, and you are in a high risk group.

The bottom line though, whatever your risk, are you going to take steps to increase that risk for your self and those around you or are you going to lower that risk?

More on COVID-19 Deaths

Getting Tested for COVID-19

Do you want or need to get tested for COVID-19? Do you know which test to get?

We have been hearing it over and over for some time now – anyone who wants a test can get a test.

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.

As testing has become more widely available, that is somewhat true.

There are still some problems with COVID-19 testing though.

Chief among them is making sure you get the right test!

Getting Tested for COVID-19

First things, first.

Do you really need a test?

Many people who are not hospitalized might not need to be tested for COVID-19.

“Most people will have mild illness and can recover at home without medical care and may not need to be tested.”

Testing for COVID-19

The main reason that testing can be important though is that it can help limit your exposing others to SARS-CoV-2 once you have been exposed or suspect you are infected. And it can also help trace the people you have already been in contact with before you knew that you should be in quarantine.

Which COVID-19 Test Do You Need

If you think you are sick and want to get tested, do make sure you get the right test though, a viral test for current infection.

You do not want the antibody test (blood test), even though it may give rapid results, if you think you are sick now. The antibody test only checks for past or recent infections.

“CDC does not currently recommend using antibody testing as the sole basis for diagnosis of acute infection, and antibody tests are not authorized by FDA for such diagnostic purposes.”

Overview of Testing for SARS-CoV-2

Once you have narrowed down your test to the viral test for current infection, you might still have a choice to make, as there are several types, including:

  • Molecular Diagnostic Tests for SARS-CoV-2 – uses nucleic acid amplification techniques (PCR) to detect the RNA of the virus. These tests don’t necessarily take long to run, but since samples typically have to be sent out to a lab, that slows down the time to get results, sometimes up to 7 business days.
  • Antigen Diagnostic Tests for SARS-CoV-2 – detects fragments of proteins that the virus makes. Can give rapid results, in 15 minutes, but are more prone to false negatives than molecular tests.

Ready to get tested now?

There is still the problem of where to get tested…

Ideally, you might want to go to some kind of mobile, drive-through testing site, so that you don’t have to expose anyone else as you get tested. Unfortunately, those kinds of testing centers are not widely available.

Another ideal choice would be your own pediatrician. Are they doing COVID-19 testing?

With the Sofia2 analyzer, pediatricians can get rapid test results in just 15 minutes.

Lastly, you might just have to see if you county or state health department has a list of places doing testing.

What to Do After Your COVID-19 Test

What happens after your test is done?

  1. You are waiting for test results. Stay in isolation until you know the results!
  2. You are positive for COVID-19. You should stay home, in isolation, unless you need medical attention, only ending your isolation until you have gone 3 days without fever AND your respiratory symptoms have improved AND it has been 10 days since your symptoms first appeared. You should also tell all close contacts (anyone who was within 6 feet of an infected person for at least 15 minutes starting from 48 hours before the person began feeling sick until the time the patient was isolated) that you tested positive so that they can self-quarantine for 14 days.
  3. You are negative for COVID-19 and don’t have symptoms after a recent exposure. Since the incubation period for SARS-CoV-2 is 7 to 14 days, a negative test before the end of the incubation period doesn’t mean that you won’t eventually develop COVID-19. You should likely remain in self-quarantine.
  4. Your COVID-19 antigen test was negative and you do have symptoms. Since this might be a false negative, depending on your health care provider’s suspicion that you could actually have COVID-19, they might now do a molecular diagnostic test for SARS-CoV-2. Or they might just recommend that you remain in self-quarantine.
  5. Your COVID-19 molecular diagnostic test was negative and you do have symptoms. Although more accurate than the antigen test, there is still the possibility that this could be a false negative. Whether or not you remain in self-quarantine depends on your health care providers suspicion that you could have COVID-19. Did you have a known, close exposure to someone with SARS-CoV-2, for example?

Are you ready to get tested?

More on Getting Tested for COVID-19

5 Things You Need to Know About COVID-19

5 things you need to know to protect yourself, your family, and your community until we finally get COVID-19 beat.

As cases start to rise again after our initial efforts to flatten the curve, you are either ready to throw up your hands, wondering what’s next, or are resigned to staying home for awhile.

“Plan A, don’t go in a crowd. Plan B, if you do, make sure you wear a mask.”

Dr. Anthony Fauci

But what if you do have to go out?

5 Things You Need to Know About COVID-19

While a lot of folks are making mistakes, it’s certainly not time to throw in the towel.

“It is important to remember that anyone who has close contact with someone with COVID-19 should stay home for 14 days after exposure based on the time it takes to develop illness.”

When You Can be Around Others After You Had or Likely Had COVID-19

Here are 5 things you need to know to protect yourself, your family, and your community until we finally get COVID-19 beat.

  1. While people probably aren’t contagious if they don’t have symptoms, they can be contagious in the days just before they develop symptoms. Unfortunately, you don’t know when that might be, which is why it is important to self-quarantine after you have been exposed (or think that you might have been exposed) for a full incubation period.
  2. Understand that SARS-CoV-2 is typically spread through close contact with someone who is infected (again, this is also in the days before they show symptoms). That means you can likely avoid getting sick if you practice social distancing (stay 6 feet away from other people), wash your hands often, and avoid touching your face, etc. To protect others, you should also cover your coughs and sneezes and wear a mask.
  3. Protect yourself if you are caring for someone at home with COVID-19, limiting contact, shared spaces, and shared personal items, etc.
  4. Avoid other people if you have COVID-19 until you are fever free for 3 days AND your respiratory symptoms are improving AND it has been at least 10 days since your symptoms first started.
  5. Get a viral test for current infection (not the antibody test) if you think you are sick and want to get tested for COVID-19.

Why is all of this important?

You can reduce your risk of COVID-19 by wearing a mask, washing your hands, and watching your distance.

Because there are still no real treatments for COVID-19, so while we wait for a vaccine, our best hope is simply to keep from getting sick.

More on COVID-19

Why There is Still So Much COVID-19 Confusion

Cognitive biases, heuristics, and logical fallacies are likely affecting how you are viewing information and advice about COVID-19.

Early on, it was easy to understand why there was so much confusion about COVID-19, after all, it took some time before we even got a real name for the new or novel virus that is causing this pandemic.

And now?

While there is still a lot more research to do, we have already learned a lot about the best ways to help prevent and treat COVID-19 infections.

Do you know who to turn to for trusted information and advice about COVID-19?

Too many people don’t seem to understand that though…

Why There is Still So Much COVID-19 Confusion

Many people also don’t understand that advice and recommendations often shift and change as we get new information.

“It is irrational to hold any view so tightly that you aren’t willing to admit the possibility that you might be wrong.”

What would it take to convince you that you were wrong?

And of course, you have to expect that to happen when you are dealing with a brand new disease!

So what are people confused about?

Everything from the effectiveness of face masks to prevent the spread of the SARS-CoV-2 virus (they do) to whether our COVID-19 death counts have been inflated (we are probably seeing under-counts).

Surprisingly, some people are still confused about just how deadly COVID-19 infections really are.

If you think made-up news and information is true, you might want to rethink where you regularly get your news and information from...
If you think made-up news and information is true, you might want to rethink where you regularly get your news and information from

Why are so many people still confused?

“Compared with other Americans, adults who “often” use social media to get news about COVID-19 report higher levels of exposure to the conspiracy theory that the pandemic was intentionally planned.”

Three Months In, Many Americans See Exaggeration, Conspiracy Theories and Partisanship in COVID-19 News

Where are they getting their information???

Who do you trust for information and advice about COVID-19?

I’m guessing it isn’t from experts…

Who to Trust About COVID-19

Adding to a lot of the confusion we are dealing with are folks pushing misinformation.

As you learn who to trust for information about COVID-19, you will hopefully develop the skills you need to be more skeptical about all of the things you see and read.

“Although my main message is that awareness of cognitive biases can lead to more effective messages and measures to mitigate the effects of the pandemic, where cognitive bias is regarded as harmful, it may be helpful to take steps to reduce such bias. Education and awareness of cognitive biases are key, so that individuals and organisations question flawed or traditional thinking habits and try to promote evidence based thinking. At an individual level, the additional advice is to slow down in your thinking, pause and reflect, and seek external views.”

Covid-19 and cognitive bias

And you will hopefully turn to sources that many of us use, including:

Still confused?

Check your biases.

Don’t let them get in your way of following the advice from the experts that could protect you and your family from getting and spreading the SARS-CoV-2 virus.

What does that mean?

Well, if you don’t think anyone should tell you to wear a mask, then you will likely look for information and advice that says masks don’t work and aren’t necessary (confirmation bias).

You will also likely not believe any information and advice that says COVID-19 is deadly.

Why?

Well, if you believed it was deadly, then you would work to avoid it and try to keep those around you safe, including doing things like wearing a mask. Instead, cognitive dissonance, the anxiety you get from believing in two things that contradict each other, will push you towards believing things that reinforce your idea that you don’t have to wear a mask.

What to Know About COVID-19 Confusion

Tired of being confused about COVID-19 and other things?

“It’s sobering to note all the ways in which human brains distort decision processes; perhaps it’s a wonder that any good decision is ever made.”

How to Make Better Decisions About Coronavirus

Be more skeptical and look for new sources of information and advice and understand how cognitive biases, heuristics, and logical fallacies affect our decision making.

More on COVID-19 Confusion

Who Are the Real COVID-19 Experts?

Don’t be confused by fake COVID-19 experts pushing their own agendas that are opposite the guidance of the real experts.

Why are you still confused about who you should listen to for advice about COVID-19 and who the real experts are?

Why is an oral surgeon treating people with COVID-19?
Why is an oral surgeon treating people with COVID-19?

The usual suspects…

Who Are the Real COVID-19 Experts?

Consider that in Texas, where COVID-19 cases are once again surging, Texas Senator Bob Hall is telling folks that they should no longer be afraid and is touting his very own COVID-19 “experts,” including:

  • Dennis Spence DDS, MD – an oral surgeon
  • Robin Armstrong, MD – an internal medicine doctor, he gave hydroxychloroquine to dozens of elderly patients in nursing homes without informed consent in his own “observational study.”
  • Brian C. Procter, MD – a family medicine doctor who has become one of Collin County’s leading Botox and Juvederm providers, and has made claims about successfully treating COVID-19 patients using “hydroxychloroquine, azithromycin, losartan, aspirin, zinc, and CBD [Cannabidiol oil] as an anti-inflammatory.” Proctor has also come out against wearing masks!
  • Richard P. Bartlett, MD – a family practice doctor, he is pushing the idea that budesonide, an inhaled steroid, is a silver bullet cure for COVID-19. Of course, that wouldn’t explain why people with asthma, who already take these drugs daily, die with COVID-19…
  • Stella Immanuel, MD – a pediatrician who continues to push the use of hydroxychloroquine.
  • Richard Urso, MD – an opthalmologist who seems to think that hydroxychloroquine should be available over the counter..

With so many docs writing scripts for their patients, it’s kind of like it is already…

Hydroxychloroquine should not be available over the counter!
Why is an ophthalmologist an expert on COVID-19?

So are any of these folks experts on COVID-19?

There is no evidence that Urso's COVID-19 cocktail will stop the SARS-CoV-2 virus.
There is no evidence that Urso’s COVID-19 cocktail will stop the SARS-CoV-2 virus.

While they are physicians, none seem to have any extra training in public health, virology, or infectious diseases.

Just as I wouldn’t go to Dr. Fauci if I had a cataract, I wouldn’t go to an ophthalmologist if I needed help dealing with a novel viral pandemic…

These folks do not seem to be experts and should likely not be making any treatment or policy recommendations that are outside their areas of expertise.

Listen to the real experts. #IStandWithFauci
Listen to the real experts. #IStandWithFauci

You should not be listening to them, especially when their recommendations go against the guidance of the real experts on COVID-19, such as:

You certainly shouldn’t be listening to politicians touting so-called experts pushing unproven and dangerous cures and treatments, as they have one goal – to make you think the COVID-19 pandemic isn’t that bad…

A naturopathic doctor had a lot to say about COVID-19 at this City Council meeting that voted to allow 4th of July activities in the city...
A naturopathic doctor had a lot to say about COVID-19 at this City Council meeting that voted to allow 4th of July activities in the city…

But how do you explain their “success” they are having with their COVID-19 patients?

The success they think they are having is built on anecdotal evidence.

“The overall cumulative hospitalization rate was 107.2 per 100,000 population. Among the 0-4 years, 5-17 years, 18-49 years, 50-64 years, and ≥ 65 years age groups, the highest rate of hospitalization is among adults aged ≥ 65, followed by adults aged 50-64 years and adults aged 18-49 years.”

COVIDView Weekly Summary

And misses the fact that most folks don’t end up in the hospital when they have COVID-19…

They also do a lot of cherry picking, ignoring any studies or evidence that show what they are doing might not be right.

“Hydroxychloroquine and chloroquine, with or without azithromycin or clarithromycin, offer no benefit in treating patients with COVID-19 and, instead, are associated with ventricular arrhythmias and higher rates of mortality, according to a major new international study.”

More Evidence Hydroxychloroquine Is Ineffective, Harmful in COVID-19

Still confused?

More on COVID-19 Experts

What to Know About Face Masks and COVID-19

Wearing a face mask is safe and may help slow the spread of COVID-19.

Why do some people still think they shouldn’t wear a mask to help control the COVID-19 pandemic?

A chain link fence won't keep out a mosquito, but it will keep out a dog covered in ticks...
A chain link fence won’t keep out a mosquito, but it will keep out a dog covered in ticks…

The usual suspects…

Confusion About Face Masks and COVID-19

Much of the confusion about face masks stems from the fact the initial guidance from the WHO and CDC said that wearing a mask wasn’t necessary for everyone.

“Wearing medical masks when not indicated may cause unnecessary cost, procurement burden and create a false sense of security that can lead to neglecting other essential measures such as hand hygiene practices. Furthermore, using a mask incorrectly may hamper its effectiveness to reduce the risk of transmission.”

Advice on the use of masks in the community, during home care and in health care settings in the context of the novel coronavirus (2019-nCoV) outbreak – WHO Interim guidance January 2020

Using a mask incorrectly?

If you are going to wear your mask under your chin or with your nose or mouth exposed and think you are protected and not social distance, then wearing a mask might actually get more people sick. With little information that masks were helpful, this fear that they would create a false sense of security likely influenced initial guidance.

Experts were likely also concerned about a limited supply of medical masks at the time.

Of course, as we have gotten more information about the SARS-CoV-2 virus and how it spreads, that guidance about face masks changed.

“CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), especially in areas of significant community-based transmission.”

Use of Cloth Face Coverings to Help Slow the Spread of COVID-19 (April 2020)

We know that the best way to avoid getting COVID-19, at least until we get a vaccine, is going to be trying make sure you are never exposed to the SARS-CoV-2 virus. In addition to social distancing and washing your hands, wearing a face mask correctly will help to decrease your risk of exposing others. And if those around you are wearing a face mask, then they won’t expose you!

What to Know About Face Masks and COVID-19

But what about the idea that the pore size of the masks are too big to stop the small size of the SARS-CoV-2 virus?

This 2009 photograph captured a sneeze in progress, revealing the plume of salivary droplets as they are expelled in a large cone-shaped array from this man’s open mouth, thereby, dramatically illustrating the reason one needs to cover his/her mouth when coughing, or sneezing, in order to protect others from germ exposure. Photo courtesy CDC/James Gathany
A sneeze in progress, revealing the plume of salivary droplets as they are expelled in a large cone-shaped array from this man’s open mouth. Photo by James Gathany.

The thing is, the SARS-CoV-2 virus, while it is very small, isn’t just floating around in the air by itself! It gets carried in and on larger respiratory droplets.

And if the mask blocks those respiratory droplets, then it should keep you from exposing others to the SARS-CoV-2 virus.

What about the claim that face masks cause folks to breath their own carbon dioxide, even leading to breathing problems?

OSHA has issued guidance to protect workers from getting COVID-19, which includes that they wear face coverings.
OSHA has issued guidance to protect workers from getting COVID-19, which includes that they wear face coverings.

Most folks realize this isn’t a real problem, after all, health professionals wear face masks all of the time without any problems, right?

But just think about these arguments…

On the one hand, they are worried that the pore size of face masks won’t block out the SARS-CoV-2 virus, which is about 0.1 μm in diameter.

But then they think these very same face masks will block carbon dioxide? How big are carbon dioxide molecules???

They are about 1000 times smaller than the SARS-CoV-2 virus…

So a face mask is not going to affect your ability to breath well.

Who Should Not Wear a Face Mask

Not surprisingly, a face mask is even recommended for folks with asthma, as long as their asthma is well controlled.

“There is no evidence that wearing a face mask makes asthma worse.”

AAAI Recommendations on the use of face masks to reduce COVID-19 transmission

Infants and toddlers under age two years can skip wearing a face mask because of the risk of suffocation, as can “anyone who has trouble breathing, is unconscious, incapacitated or otherwise unable to remove the mask without assistance.”

If you have “trouble breathing” though, you likely have a severe respiratory condition and you aren’t simply someone who doesn’t want to wear a mask.

Flyers about the Americans with Disabilities Act (ADA) and the use of face masks due to the COVID-19 are fake.

And there are no face mask exemptions under the Americans with Disabilities Act (ADA).

People are selling fake face mask exemption cards.
People are selling fake face mask exemption cards.

Are you ready to put on a mask now?

Since we are seeing higher rates of COVID-19 in states that don’t have mask mandates, the only confusion should be over why anyone still won’t wear a mask when they are around other people.

More on Controlling COVID-19

The Experts Defending Anthony Fauci

Anthony Fauci is receiving a lot of support from doctors, scientists, and public health experts.

Not surprisingly, more and more experts are speaking out to defend Dr. Anthony Fauci.

Anthony Fauci is receiving a lot of support from doctors, scientists, and public health experts.
Anthony Fauci is receiving a lot of support from doctors, scientists, and public health experts.

These experts understand that Dr. Fauci “deserves our deepest gratitude and support” and is “our best hope in these challenging times.”

The Experts Defending Anthony Fauci

Harold Bauchner certainly wasn’t alone in stating his public support for Dr. Fauci.

“As 12,000 medical doctors, research scientists and public health experts on the front lines of COVID-19, the infectious diseases community will not be silenced nor sidelined amidst a global pandemic. Reports of a campaign to discredit and diminish the role of Dr. Fauci at this perilous moment are disturbing.”

IDSA Statement in Support of Anthony Fauci, M.D.

The Infectious Disease Society of America issued their own statement.

“If we have any hope of ending this crisis, all of America must support public health experts, including Dr. Fauci, and stand with science.”

IDSA Statement in Support of Anthony Fauci, M.D.

And so did the Association of American Medical Colleges, whose members comprise all 155 accredited U.S. and 17 accredited Canadian medical schools; nearly 400 major teaching hospitals and health systems, including 51 Department of Veterans Affairs medical centers; and more than 80 academic societies, with 173,000 faculty members, 89,000 medical students, 129,000 resident physicians, and more than 60,000 graduate students and postdoctoral researchers in the biomedical sciences.

“The AAMC is extremely concerned and alarmed by efforts to discredit Anthony Fauci, MD, our nation’s top infectious disease expert. Dr. Fauci has been an independent and outspoken voice for truth as the nation has struggled to fight the coronavirus pandemic….

Taking quotes from Dr. Fauci out of context to discredit his scientific knowledge and judgment will do tremendous harm to our nation’s efforts to get the virus under control, restore our economy, and return us to a more normal way of life.

America should be applauding Dr. Fauci for his service and following his advice, not undermining his credibility at this critical time.”

AAMC Statement in Support of Anthony Fauci, MD

Hopefully Dr. Fauci knows how much the majority of people value his work and trust his opinions.

“We have been very fortunate to have Dr. Anthony Fauci at the helm directing infectious diseases research at NIH for so many years. His leadership and support of a rigorous scientific process has been critical to transforming HIV from a death sentence to a chronic condition​, saving millions of lives worldwide. His voice and expertise need to be amplified not silenced if we are going to get control of the COVID-19 pandemic​, which has now taken the lives of more than 135,000 Americans and more than 570,000 people worldwide.”

HIV Medicine Association Stands with Science and Anthony Fauci, MD

And we know that the only way out of the COVID-19 pandemic is with our public health experts, like Anthony Fauci, leading the way.

“In his role as Director of the National Institute of Allergy and Infectious Diseases (NIAID), Dr. Fauci has fostered a longstanding and productive collaboration with the ATS. He has faithfully served the American people through six presidential administrations, always providing sound, science‐based guidance to threats large and small. As we move forward to combat COVID‐19, his scientific knowledge, expertise, and counsel will continue to be of critical importance.”

Statement by the ATS Executive Committee supporting Anthony S. Fauci, M.D., Director, National Institute of Allergy and Infectious Diseases

As cases of COVID-19 once again surge, one thing is becoming clear:

Science, not politics, must guide COVID-19 response

AIBS Supports Dr. Fauci

We can’t wish the SARS-CoV-2 virus away…

I am a pediatrician and #IStandWithFauci.

We need health experts like Anthony Fauci to help guide us through this. And we need people to listen to his advice.

More on Anthony Fauci

What Did the AAP Say About Sending Kids Back to School?

The AAP has offered guidance for a safe way to get our kids back in school during the COVID-19 pandemic. Will schools follow any of it when they open up?

The American Academy of Pediatrics recently issued some guidance about what to do about kids going to school this fall.

The AAP said a lot more than that parents should send their kids back to school. They offered guidance on how to safely send kids back to school...
The AAP said a lot more than that parents should send their kids back to school. They offered guidance on how to safely send kids back to school…

Not surprisingly, folks are a little confused about what they actually said…

What Did the AAP Say About Sending Kids Back to School?

It is true, the AAP guidance does favor opening up schools this fall.

“With the above principles in mind, the AAP strongly advocates that all policy considerations for the coming school year should start with a goal of having students physically present in school. The importance of in-person learning is well-documented, and there is already evidence of the negative impacts on children because of school closures in the spring of 2020. Lengthy time away from school and associated interruption of supportive services often results in social isolation, making it difficult for schools to identify and address important learning deficits as well as child and adolescent physical or sexual abuse, substance use, depression, and suicidal ideation. This, in turn, places children and adolescents at considerable risk of morbidity and, in some cases, mortality. Beyond the educational impact and social impact of school closures, there has been substantial impact on food security and physical activity for children and families.”

COVID-19 Planning Considerations: Guidance for School Re-entry

But, that isn’t all they said…

The goal is for kids to be in school this fall...

To get to that goal of opening schools, the AAP offered a list of key principles that schools should follow, including that:

  • school policies are going to have to be “flexible and nimble” so that they can quickly change as we get new information, especially “when specific policies are not working”
  • schools develop strategies that depend on the levels of COVID-19 cases in the school and community
  • schools make special considerations and accommodations for those who need them, “including those who are medically fragile, live in poverty, have developmental challenges, or have special health care needs or disabilities, with the goal of safe return to school”

So clearly, this is not a one-size-fits-all, lets open up schools no matter what kind of thing.

“Highest Risk: Full sized, in-person classes, activities, and events. Students are not spaced apart, share classroom materials or supplies, and mix between classes and activities.”

CDC on Considerations for Schools

The AAP didn’t say to simply open up schools without doing anything else…

“No single action or set of actions will completely eliminate the risk of SARS-CoV-2 transmission, but implementation of several coordinated interventions can greatly reduce that risk. For example, where physical distance cannot be maintained, students (over the age of 2 years) and staff can wear face coverings (when feasible). In the following sections, we review some general principles that policy makers should consider as they plan for the coming school year. For all of these, education for the entire school community regarding these measures should begin early, ideally at least several weeks before the start of the school year.”

COVID-19 Planning Considerations: Guidance for School Re-entry

They offered guidance on how to safely open schools.

Or at least how to open schools as safely as possible, as the alternative of keeping kids at home has risks too. And many people are skeptical that a strategy of closing schools is all that helpful in controlling the spread of SARS-CoV-2.

So the AAP guidance says that we open schools and also plan for:

  • Physical distancing – cohort classes, block schedules, rotating teachers instead of students, etc.
  • Cleaning and disinfecting
  • Testing and screening – schools will need a rapid response plan for when a child or staff member develops a fever at school.
  • Face Coverings and PPE – although it won’t be possible in all situations and for all children, “school staff and older students (middle or high school) may be able to wear cloth face coverings safely and consistently and should be encouraged to do so.”
  • Organized Activities – although this isn’t something most folks want to hear, they should understand that opening schools doesn’t mean that everything will be back to normal… “It is likely that sporting events, practices, and conditioning sessions will be limited in many locations.”

If we do all of that, will it really be safe to go to school with these guidelines?

Unfortunately, the most important part of the guidelines, the section on Testing and Screening, was a bit light on details…

“Parents should be instructed to keep their child at home if they are ill.”

COVID-19 Planning Considerations: Guidance for School Re-entry

The guidelines acknowledge that it will be too hard to do temperature checks and symptom screening each day and that schools should have a rapid response plan if anyone has a fever had school, but then what?

“Here in Colorado, I’ve been following our state health department website very closely. They update data every day and include the outbreaks in the state they are investigating. As you can imagine, there are lots and lots in long-term care facilities and skilled nursing homes, some in restaurants and grocery stores. There have been a total of four in child care centers, and we do have a lot of child care centers open. In almost every one of those cases, transmission was between two adults. The kids in the centers are not spreading Covid-19. I’m hearing the same thing from other states, as well.”

Why a Pediatric Group Is Pushing to Reopen Schools This Fall

So what’s going to happen if kids in school start to get sick and test positive for COVID-19?

Among the 950 COVID-19 in Texas daycare centers are 307 children.
Among the 950 COVID-19 in Texas daycare centers are 307 children. (Dallas Morning News)

The 60,000 members of the AAP who didn’t participate in writing the guideline know what’s going to happen…

A ton of parents from the school are going to call their pediatricians looking to get their kids tested!

What likely should happen?

That classroom or cohort and their close contacts should move to self-quarantine and home/online education until they pass the incubation period from their last contact.

“Put in place the infrastructure and resources to test, trace and isolate new cases.”

Safely Reopening America’s Schools and Communities

(I’m guessing we will get more details about this from the AAP soon and well before school starts. )

Most importantly though, our communities should do everything they can to keep their case counts down – wash hands, practice social distancing, wear a face cover.

And if we are going to send our kids back to school, we should make sure that we are protecting all of the folks making that possible.

Can we do all of that?

Sure!

Will we???

Sending Your Kids Back to School

Are you still unsure about whether or not you should send your own kids back to school?

I don’t blame you…

Some things to consider when making the decision:

  • is your child or any of their contacts at risk for a more severe case of COVID-19, including having an underlying, chronic medical condition, keeping in mind that the risk increases with age, especially once you reach age 65 years? If possible, online schooling might be a better option for students in high risk categories.
  • was staying home from school hard for your child? If your child had problems learning at home or the social isolation was an issue, than that would make going back to school even more important.
  • will your school or school district be “flexible and nimble” and respond to new information, rising case counts, and evolve their policies if necessary?

Most importantly, if you send your kids back to school, are you going to be constantly worried that they are going to get COVID-19 or bring home the SARS-CoV-2 virus? If so, then keep them home this fall.

On the other hand, if they are healthy, have no high risk contacts at home, and are eager to go back to school, then you should probably feel comfortable sending them if the school follows the guidance offered by the AAP.

More on COVID-19

Why Are Social Distancing Kids Still Getting Sick?

Why are some kids still getting sick if they are have been our of school and stuck in the house for weeks because of COVID-19?

COVID-19 has kept most kids out of school for some time now. Many are also out of daycare. And few are out playing with friends.

So why are some still getting sick? What else is going on with kids stuck at home while we are all social distancing to flatten the curve.

Why Are Social Distancing Kids Still Getting Sick?

The first thought of some parents and pediatric providers upon reading this might be, wait, what, kids are still getting sick?

Flu activity is low in most of the United States.
Flu activity is low in most of the United States.

And that’s because it does seem that in addition to flattening the COVID-19 curve, staying home from school and daycare, washing hands, and general social distancing techniques has worked to keeps from getting sick with the flu and most other contagious diseases!

So while pediatric providers are available to do telemedicine appointments, it certainly isn’t business as usual, even as their days have gotten quite unusual.

Some kids are still getting sick though, and while we know what you are thinking, most probably don’t have COVID-19.

Why?

It might be because:

  1. they aren’t social distancing as well as they think they are, keeping in mind that with many diseases, people can be contagious for a few days before they show symptoms and you can sometimes catch germs from touching fomites, or objects that a sick person has recently touched. That still doesn’t mean that they have COVID-19 though. If they have contact with others, they could catch almost anything.
  2. they caught something from someone who had a disease a few weeks or months ago and is still shedding. For example, some infants can shed RSV for as long as 4 weeks after they get better. And they can shed the virus that causes hand, foot and mouth disease (HFMD) for almost two months! Human parainfluenza viruses (HPIV), a common cause of colds and croup (seal bark cough), can also shed for many months.
  3. they caught something from someone who had a viral disease that causes a lifelong latent infection with periodic reactivation and shedding. Wait, what? While herpes (cold sores) is the main disease you might think of as causing a lifelong latent infection, there are others. You may not realize this, but after getting roseola (causes a high fever for a few days, followed by a rash after the fever breaks), HHV-6 (human herpes virus-6) kind of does the same thing. The big difference is that while you shed HHV-6 in your saliva from time to time, you don’t have any symptoms. You can get other folks sick though, especially older infants, once they lose the passive immunity they got from maternal antibodies.
  4. they have a sore throat caused by a virus, allergies, or reflux, but have tonsil stones and a positive strep test because they are a strep carrier. Nearly 20% of kids are thought to be carriers of strep, which means that every time they get tested, they will be positive, whether or not they actually have strep throat. That means that you don’t have to worry about testing the dog to see if they are carrying strep…
  5. they were exposed to a disease with a long incubation period. While the incubation period (the time between getting exposed to something to when you get sick) is just a few days for many diseases, it can be several weeks or months for others. In fact, your child might not get sick until 30 to 50 days after being exposed to someone with mono!
  6. they had a virus a few weeks ago and now have Gianotti Crosti syndrome (GCS), a post-viral rash on a child’s legs, arms, and buttocks. Although GCS might linger for weeks or months, it eventually goes away on its own. Another rash, this one likely caused by reactivation of the virus that causes roseola, might have you thinking your child is covered in ringworm (how would they get that if they haven’t left the house??). Instead, they likely have pityriasis rosea.
  7. their symptoms are caused by a non-contagious infectious disease that is spread from an animal or insect and not from another person – think Lyme disease (ticks), Cat scratch disease (cats), and West Nile virus (mosquitoes), etc.
  8. they got sick (bacteria, virus, or parasite) from contaminated lake or well water, which can cause diarrhea – giardiasis, Crypto, shigellosis, norovirus,
  9. they got sick (bacteria, virus, or parasite) from eating raw or contaminated food – giardiasis, shigellosis, norovirus, E. coli, salmonellosis
  10. their symptoms are caused by a non-infectious disease, which could be anything from allergies and asthma to poison ivy or herpes zoster (shingles).

It is also possible that their symptoms are being caused by anxiety, fear, and stress, which is not unexpected as they see schools closed, people getting sick and wearing masks, and are likely unsure about what’s coming next.

Has your child been sick recently?

Do you have a pet turtle or chickens in your backyard? They could be a source for Salmonella…

Do you understand why now?

Now call your pediatric provider if you have questions and need help getting them well, especially if they seem anxious or have extra stress from being home all of the time and away from school and their friends.

You especially want to call if you think that they might actually have COVID-19. While most kids have mild symptoms or are asymptomatic, if your child has a fever, cough, and difficulty breathing, you should call your pediatric provider or seek medical attention.

More on Covid-19 Kids Getting Sick

Telemedicine for Parents and Pediatric Providers

Ideally, we would continue to see kids in our office when they are sick, but until the COVID-19 pandemic is over, telemedicine is a great alternative to help us keep all of our kids healthy and recognize when they are truly sick, perhaps even needing immediate medical attention.

Many parents and pediatric providers are getting a crash course in telemedicine because of the COVID-19 pandemic.

Although using virtual visits when kids are sick certainly isn’t a new idea, many things have gotten in the way of making online visits to pediatric offices more popular. Chief among them is the simple fact that most people prefer an in-person, in-office visit.

Telemedicine for Parents and Pediatric Providers

Unfortunately, with the risk of spreading the SARS-CoV-2 virus, even when kids don’t have symptoms, in-office visits aren’t always possible and certainly aren’t always safe anymore.

That doesn’t mean that your pediatric provider is going to close, as other non-essential businesses are doing.

Newborns, infants, children, and teens still need to be seen for essential preventative care and when they are sick.

Be flexible. Consider modifying your clinical schedule and physical space to minimize risk. Increase capacity to deliver telehealth when possible.”

Sally Goza, MD, FAAP President, American Academy of Pediatrics

Still, we are going to have to change how we provide that care until the COVID-19 pandemic is over.

Remember, while it is true that kids aren’t thought to be at risk for severe COVID-19 symptoms, they likely can still get and spread the spreading SARS-CoV-2 virus.

That’s why most pediatric providers are encouraging patients with fever and respiratory symptoms (URI, cough, runny nose, difficulty breathing) to stay home and are instead moving to phone/virtual consultations.

And with community spread in more and more areas, many are switching to telemedicine visits for any non-essential visit. Is your child due for an ADHD recheck? Do you need to discuss test results or need your pediatrician to look at a rash? Is your child constipated? With the risk of COVID-19, these are all ideal reasons to ask for a telemedicine appointment instead of visiting the office.

“Aetna announced it will offer zero co-pay telemedicine visits nationally for any reason for the next 90 days for all commercial plans. Humana, Blue Cross Blue Shield of Massachusetts, Horizon Blue Cross Blue Shield of New Jersey, and others have announced similar expansions of telehealth coverage.”

Opportunities To Expand Telehealth Use Amid The Coronavirus Pandemic

Before COVID-19, the simple fact that most insurance companies didn’t pay for telemedicine visits got in the way of there becoming more popular. That’s changed now, as have some laws and regulations (especially HIPAA restrictions) that had previously made it harder to do telemedicine.

Making the Most of Your Telemedicine Visit With Your Pediatric Provider

While some parents likely are excited about doing telemedicine visits, since they can be more convenient than visiting the office, many others probably still have doubts.

However you feel about it, since it is likely that your child might need a telemedicine visit before this is all over, let’s look at how we can all make the most of it.

To start, if possible, make the telemedicine visit with your usual pediatric provider or someone else in their office. Sign their telehealth consent form and review other polices and procedures before your online appointment.

It can also help if, just before the visit, you:

  • weigh your child
  • check your child’s temperature
  • check your child’s heart rate or pulse
  • check your child’s respiratory rate (count the breaths per minute)
  • write down all of the medicines your child has been taking
  • write down all of your child’s symptoms, including how long they have had them and if they are getting better or worse
  • write down how your child’s symptoms are affecting their eating, sleeping, and other activities, for example, are they drinking fluids, playful, consolable, or are they just crying all of the time?
  • write down any questions you have, as you might forget them during the telemedicine visit!
  • make sure you have a flashlight handy in case your provider wants to take a look at your child’s throat. Maybe even practice having them open wide before the visit.

And most importantly, understand how you are going to connect to your pediatric provider for the online visit! Are you using Facetime, Skype, or a website like doxy.me, etc?

Telemedicine Do’s and Don’ts

Are you and your child (yes, you want your child to be with you during the telemedicine visit!) ready for your first telemedicine visit with your pediatric provider?

Do have everything ready at home and be prepared for when your pediatric provider “shows up” to the visit.

It is also a good idea that you:

  • don’t use medical terminology, like lethargic (is your child really hard to wake up?), dehydrated (just mention the last time your child urinated, etc.), or say that your child is having trouble breathing (is your child breathing fast and hard or having trouble catching their breath?) – instead, just describe what your child is doing and how they are acting, which, since it is a telemedicine visit, your provider will actually get to see for themselves!
  • don’t say that you can’t control your child’s fever, if what you really mean is that it goes back up after their fever reducer wears off, and remember that fever is typically just a symptom, like a cough or runny nose, and not a sign of how sick your child is
  • don’t ask for or expect a prescription, especially for an antibiotic, just because you had an online visit with your provider. Studies have found high rates of antibiotic prescribing during telemedicine visits, especially for kids with respiratory infections, and that hopefully won’t continue as telehealth becomes more popular.
  • avoid sitting in a dark or noisy room, as that will make it harder for your provider to see and hear you

And at the end of the visit, make sure you understand your child’s diagnosis, recommendations for treatment, and most importantly, don’t forget to ask when you should expect that your child should begin to get better and the signs to look for that might indicate that they are getting worse.

“We recognize we are all practicing pediatrics in circumstances we have never encountered before in our careers.”

Sally Goza, MD, FAAP President, American Academy of Pediatrics

Are there limits to telemedicine?

Sure.

We can’t sew up a cut that needs stitches, for example, but you know what? If your child falls and cuts themselves, we can do a telemedicine visit to let you know if they do need stitches, maybe saving you a visit to the office or the ER.

Ideally, we would continue to see kids in our office when they are sick, but until the COVID-19 pandemic is over, telemedicine is a great alternative to help us keep all of our kids healthy and recognize when they are truly sick, perhaps even needing immediate medical attention.

More on Telemedicine for Parents and Pediatricians

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