CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 01/06/2021

1/6/2021

HELLO :

We have several pediatric articles for those with children and grandchildren. Facebook and KMHT Radio might have updated vaccine availability information.

Marshall Manor receives first doses of COVID-19 vaccine

Administrator Ross Bradfield said that the majority of the vaccines distributed on Tuesday by Walgreens at the facility were given to residents of the home.

Covid-19 Live Updates: Scientists Are Studying Whether Moderna Supply Can Be Doubled By Cutting Doses in Half

The data analysis…has been long-planned as part of the vaccine research effort, comes amid a broader scramble to increase vaccine supply…data from Moderna’s clinical trials demonstrated that people between the ages of 18 and 55 who received two 50-microgram doses showed an “identical immune response” to the two 100-microgram doses….(J. Harris: Maybe)…The vaccine rollout has been troubled from the start. For the moment, the problem is not a shortage of vaccine, but rather that state and local governments are having trouble distributing the vaccine doses they already have.

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PEDIATRIC CONSIDERATIONS: TEXT WRITTEN BY DR. SETH GORDON, A PEDIATRICIAN FROM NY AND FROM WHOM I COPIED THE FOLLOWING FROM AN EMAIL HE SENDS TO HIS PATIENTS AND FRIENDS AND MY SON IN LAW IN CALIFORNIA.

(I looked him up and he’s a real working Pediatrician. I chopped his mailout up a bit and fiddled around with the presentation but not the facts. We may seem more of his work later):

MIS-C: Multi-System Inflammatory Syndrome in Children

Where are you hiding?

” As we began to open up, my main concern from a pediatric perspective has always been MIS-C more than Covid. If 0.1 % of Covid cases went on to have MIS-C, you would have between 150-450 cases of MIS-C a week. MIS-C has already led to approximately 1500 hospitalizations ( though this a grave underestimation) and 23 child fatalities ( most states don’t differentiate between MIS-C vs Covid). From July to December 4 th rates of MIS-C have risen by 125 %.

“MIS-C has been diagnosed in children from a few months to 20 years of age. The symptoms of MIS-C often present 4-8 weeks after a known and in most cases an unknown asymptomatic COVID case. Therefore, it is important to test and diagnose any exposed child for Covid and not to wait for symptoms, which may never occur. MIS-C symptoms are brought on by a delayed hyperimmune response which results in an inflammatory process that affects blood vessels in many different organs. The most serious of which, is in the heart, and can lead to a coronary aneurysm. This is why early identification is critical. Other symptoms that can be identified by parents include:

1 Bloodshot eyes

2 Fever 100.4 of greater

3 Abdominal pain, Diarrhea or Vomiting

4 Skin rash

5 Swelling of hands or feet

6 Cracked dried out lips

7 Change skin color pale, blue or blotchy

8 Trouble breathing

9 Racing heart

10. Lethargy, Confusion, or Irritability

10 Infants- difficulty feeding or sick to drink

“What concerns me most, is the seemingly benign nature of the initial symptoms which often present in the GI tract (abdominal pain, diarrhea, and/or vomiting) and can be similar to the flu. Care avoidance has resulted in some children with mild symptoms turning severe very quickly. Dr. Jane Burns, the director of the Kawasaki Disease Research Center at UC San Diego recently expressed the dilemma best in the LA Times. “ There are kids that are not sick enough to be admitted. Then there are children that go directly into shock with multi-organ failure. We don’t understand why the heart muscles basically pump poorly in these children.”

Dr. Gordon continues: “Children have been overshadowed by the more imminent [disease] threat to adults and the inevitable comparison “that children have it better.’ There is a culture of first denying Covid exists in children, and then minimizing its extent and consequences. This coincides with a well-meaning effort to keep schools open and normalize life. MIS-C highlights some of the risks and unknowns associated with rising Covid rates in the general population filtering down to affect children.”

Dr. Gordon adds: School/Statistics/UK Mutation

“I supported the opening of in person learning August-Nov. For the most part it was successful. But [now], I do not think schools should reopen before we have established a sustained downward curve. The models have been very accurate and most predict we will peak in mid February. I believed that the 3 percent positive rate (while an imperfect statistic) was a real number not a moving target. For the past 5 months, all the indicators ….have moved steadily in the wrong direction. All of NYS neighboring states are doing progressively worse. Rates have become high enough that infection has become pervasive. There is no school or community that will not become infected. The UK mutation is here already. It is more easily spread (perhaps 50-70% more contagious) and especially in children. Knowing these facts and the history of second wave pandemics, it is inevitable that our situation will continue to worsen in the next month. So by continuing on as is, we are only tempting fate. The medical oath is “ to do no harm”. Simply put, if you feel an action represents a real potential for harm, you are better off not doing it. I think attending school now represents a real potential for harm for the students (short term and unknown long term), the teachers, and the community as a whole. When risks have been relatively successfully navigated, it emboldens people to take ever greater risks (ie the school has opened and no one has become seriously ill). It also results in a herd bull market mentality. When logic and statistics dictate that we exit, some schools are just starting up and others are doubling down with more class time so they are not left out. No matter what the outcome is, the right move is to be thankful for your health and success so far, take a break, and play a better hand in March.

Best wishes for the new year,

Seth Gordon, MD

New York, New York

Symptomatic and Asymptomatic Viral Shedding in Pediatric Patients Infected With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) August 28, 2020 (J. Harris: This may have been mailed out previously, but if you have contact with children, you might want to read the entire article)

“Han and colleagues13 provide data accumulated from 22 centers throughout South Korea that address this important knowledge gap. The unique structure of the South Korean public health system facilitated large-scale testing, aggressive contact tracing and testing, and isolation/direct observation of asymptomatic or mildly symptomatic children in designated health care facilities (rather than home quarantine). This structure allowed for the sequential observation, testing (median testing interval of every 3 days), and comparison of 91 asymptomatic, presymptomatic, and symptomatic children with mild to moderate upper and lower respiratory tract infection, identified primarily by contact tracing from laboratory-proven cases.

“The first important take-home point from this study is that not all infected children have symptoms, and even those with symptoms are not necessarily recognized in a timely fashion. A major strength of this study is the inclusion of asymptomatic children (20 of 91 [22%]), presymptomatic children (18 of 91 [20%]), and symptomatic children (53 of 91 [58%]).13 Most symptomatic infected children had experienced symptoms a median (range) of 3 (1-28) days prior to being diagnosed by testing, despite the fact that they were presumably under closer scrutiny by nature of being identified as a known contact. Presymptomatic children remained symptom free for a median (range) of 2.5 (1-25) days before exhibiting any symptoms, despite detectable virus. Only a minority of children (6 [7%]) were identified as infected by testing performed concurrent with onset of their symptoms. This highlights the concept that infected children may be more likely to go unnoticed either with or without symptoms and continue on with their usual activities, which may contribute to viral circulation within their community.

“Fully half of symptomatic children with both upper and lower tract disease were still shedding virus at 21 days. These are striking data, particularly since 86 of 88 diagnosed children (98%) either had no symptoms or mild or moderate disease.

“In summary, the study by Han et al13 highlights that a large percentage of infected children may be asymptomatic or presymptomatic despite infection with SARS CoV-2 and that both asymptomatic and symptomatic individuals may shed virus for prolonged periods of time (2 to 3 weeks) regardless of symptoms. These findings are highly relevant to the development of public health strategies to mitigate and contain spread within communities, particularly as affected communities begin their recovery phases.”

J. Harris: Sick children can also have viable Covid viruses in other bodily fluids and waste. This article, and the first article above by Dr. Gordon, have convinced me that asymptomatic school children can be infected carriers of Covid and schools should not teach “in person.” I would have preferred that schools wait several weeks to months to reopen in person. I suspect that there are one or two school teachers who wish the same thing. I suspect that subsequent studies will also find that some of the ill children will have the more easily spread mutant viruses. I try not to be an alarmist, but, for a while, I am persuaded that school should be OUT.

1 in 4 children visited an urgent care, retail clinic in 2019

Summary

In 2019, just over one in four U.S. children had one or more visits to an urgent care center or retail health clinic (26.4%) in the past 12 months. Utilization varied by age group and race and Hispanic origin. Children who had private or public health insurance coverage were more likely to have had one or more visits to urgent care or retail health clinics compared with children who were uninsured. Urgent care center and retail health clinic utilization increased with increasing parental education and family income, a pattern consistent with previous studies (6). The level of convenience in accessing health care may be a factor for parents when choosing to seek care for their children at urgent care centers and retail health clinics (6,7).