Dr. Farber’s further look at coronavirus (COVID-19)

This has been quite a week; things moved much faster than I had wanted (and hoped) they would.  I will address five topics in this post.

1.  What will happen in the short term?  This is the easiest.  The numbers will rise dramatically.  Part of this will be due to an increase in testing, but the vast majority of it will be because the disease is out there and spreading fast.  We are unfortunately starting to see more deaths in young adults, which was, however, not unexpected.  We are going to see more cases in children, and some will have serious illnesses.  However, even in countries which have been devastated, such as Italy, children have remained relatively spared, and I expect that to continue, for which I am thankful.

2.  What can you do to protect your child?  You’ve heard it before, but it’s still true:  keep your hands away from your face, WASH YOUR HANDS, and practice social distancing (and isolation/quarantine if you are ill).  If you do go out, say to a store, wear a face mask if you have one; despite initial reports, these are helpful.  For your child, no play dates.  However, it is spring.  Go outside with your child several hours a day. Go to the park (not the playground though), walk along creeks, toss a frisbee, ride bikes (with helmets of course), etc.  Indoors, do crafts, read books, play board games.  I know that electronic use will go up during this time, but still try to limit it. Healthychildren.org has a good page on developing a family media plan.

3.  What should I do if my child is ill?  The vast majority of children will do fine, and just need symptomatic care:  rest, fluids, fever relief, honey for coughs if over one year old, etc.  There are many treatments being advocated on the internet; be aware that this is an area ripe for scamming.  Chloroquine has been suggested as a possible treatment.  There is scanty evidence that it might be effective, enough that I think it is reasonable to give it to people who are truly ill, but not to others.  I have three reasons for not prescribing it for children who are mildly ill.  The first is that it is unproven, and although relatively safe, does have side effects; why chance making a child worse if there is no need?  The second is that we may run into a shortage, and we should have it available for those who truly need it.  The third is theoretical; if we allow the medicine to defeat the virus, rather than the child’s own body, it can blunt the immune response and leave the child susceptible for the next time it comes around.

4.  What is the long-term outlook?  It will eventually go away.  Optimistically, it would fade with warmer weather, as is true for the flu.  However, COVID-19 is not the flu, and this will probably not happen, although I can hope.  Thus, we will need to look to ourselves, and not nature, to take care of the problem.

The prototypical country to review here is South Korea.  South Korea was well prepared.  They had plenty of masks and gloves and sanitizer, jumped on testing and quarantine right away, got the word out to their people in a timely and consistent fashion, and had a population which, having lived through a SARS epidemic, took notice.  They hit their peak infection rate at two weeks into the pandemic after which it started to drop, and now, four weeks into it, their numbers are very manageable, although the virus is still active.

We are not going to duplicate that.  We are four weeks in and still climbing.  We have a nationwide shortage of masks and sanitizers and gloves.  We are unable to test everybody who would benefit from testing.  There are still plenty of pundits who feel that COVID-19 is a minor illness, or even a hoax.  We may have shut down our borders, and locked down some cities, but the virus is going to be with us for some time still, and will continue to travel within our country.

I am confident we will not be as badly hit as Italy, but we are still in for a long stretch.  Some institutions are planning on re-opening in mid-April; I think that is highly unlikely.  If someone could guarantee me that things would start to normalize by the end of April, I would take that. I think it is possible, but expect it will take longer.

5.  How will you know when the crisis is passing?  As I stated in my previous blog, I expect institutions to reopen later rather than earlier (e.g., Virginia schools).   Thus, if the state government (not the federal government – this is something that should be decided locally) feels that restaurants can reopen for regular business, although the virus will still be around at that time, and we will still need to exercise care, it will be manageable.  The most obvious sign that things are improving will be when the number of cases is clearly falling; this means looking at week-by-week numbers, not day-by-day; the latter are too variable.  For me, although morbid, I will take a clear drop in the absolute number of deaths per week as the most likely first positive sign that we are turning the corner.

My final thoughts:  wash your hands well, get outside as a family, and remember that this is not the end of the world.  Prudence, not panic.

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